Provider Demographics
NPI:1770379695
Name:COLON RODRIGUEZ, GLORIANIE DEL MAR
Entity type:Individual
Prefix:
First Name:GLORIANIE
Middle Name:DEL MAR
Last Name:COLON RODRIGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 450 BOX 715
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09705-1008
Mailing Address - Country:US
Mailing Address - Phone:210-571-5690
Mailing Address - Fax:
Practice Address - Street 1:CMR 450 BOX 715
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09705-1008
Practice Address - Country:US
Practice Address - Phone:210-571-5690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist