Healthcare Provider Details

I. General information

NPI: 1720388564
Provider Name (Legal Business Name): LORENA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N KENDALL DR SUITE 604E
MIAMI FL
33176-2148
US

IV. Provider business mailing address

8940 N KENDALL DR SUITE 604E
MIAMI FL
33176-2148
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-1905
  • Fax: 305-595-2219
Mailing address:
  • Phone: 305-595-1905
  • Fax: 305-595-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: