Healthcare Provider Details

I. General information

NPI: 1780817403
Provider Name (Legal Business Name): SONIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9242 TELEGRAPH RD APT B12
DOWNEY CA
90240-2493
US

IV. Provider business mailing address

9242 TELEGRAPH RD APT B12
DOWNEY CA
90240-2493
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-9933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number4480962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: