MEDICARE: PATRICIA RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN24428	FL
2	122300000X	Dentist	14089	NC

General Provider Information

NPI Number	:	1225684699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA RODRIGUEZ

Provider Business Mailing Address
First Line	:	19407 BOOTH BAY CT
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-3705
Country	:	US
Telephone Number	:	954-740-9485
Fax Number	:

Provider Business Practice Location Address
First Line	:	9380 SULLIVAN VALE LN STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-7076
Country	:	US
Telephone Number	:	704-954-8548
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	05/12/2025

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Directions to “ PATRICIA RODRIGUEZ ” Practice Location

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