Provider Demographics
NPI:1740639095
Name:DELGADO-RODRIGUEZ, ROXANNA
Entity type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:DELGADO-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 CALLE VERONA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4060
Mailing Address - Country:US
Mailing Address - Phone:787-342-9049
Mailing Address - Fax:
Practice Address - Street 1:5225 TOUHY AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3245
Practice Address - Country:US
Practice Address - Phone:847-807-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6232756OtherDRIVERS