Healthcare Provider Details

I. General information

NPI: 1912164609
Provider Name (Legal Business Name): EFREN P RODRIGUEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10421 HOLE AVE
RIVERSIDE CA
92505-1617
US

IV. Provider business mailing address

10421 HOLE AVE
RIVERSIDE CA
92505-1617
US

V. Phone/Fax

Practice location:
  • Phone: 951-687-3500
  • Fax:
Mailing address:
  • Phone: 951-687-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: