Healthcare Provider Details

I. General information

NPI: 1316242274
Provider Name (Legal Business Name): GUILLERMINA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 SEPULVEDA BLVD
TORRANCE CA
90505-2408
US

IV. Provider business mailing address

13817 S CATALINA AVE
GARDENA CA
90247-2042
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-5200
  • Fax:
Mailing address:
  • Phone: 310-999-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number186-10222007100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: