Healthcare Provider Details

I. General information

NPI: 1821782905
Provider Name (Legal Business Name): MS. KATHERINE COLON RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18312 PINES BLVD
PEMBROKE PINES FL
33029-1412
US

IV. Provider business mailing address

18312 PINES BLVD
PEMBROKE PINES FL
33029-1412
US

V. Phone/Fax

Practice location:
  • Phone: 786-204-0713
  • Fax:
Mailing address:
  • Phone: 786-204-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: