MEDICARE: DR. ALEXANDRA SOFIA RODRIGUEZ DMD

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	1223P0221X	Pediatric Dentistry	2410	PR

General Provider Information

NPI Number	:	1467422881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDRA SOFIA RODRIGUEZ DMD

Provider Business Mailing Address
First Line	:	MANSIONES DE GARDEN HILLS
Second Line	:	ST. #8 D-3
City	:	GUAYNABO
State	:	PR
Zip	:	00966
Country	:	US
Telephone Number	:	787-782-2195
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 CALLE YANGTZE
Second Line	:	RIO PIEDRAS HEIGHTS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3152
Country	:	US
Telephone Number	:	787-758-5120
Fax Number	:

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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