Healthcare Provider Details

I. General information

NPI: 1093154460
Provider Name (Legal Business Name): GLENDA L. RODRIGUEZ AGUIAR D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 01/31/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANATI MEDICAL PLAZA 1 CALLE JOSE CANDELAS SUITE 208
MANATI PR
00674-5527
US

IV. Provider business mailing address

HC 1 BOX 9354
TOA BAJA PR
00949-9769
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-6478
  • Fax:
Mailing address:
  • Phone: 787-604-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3211
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3211
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier102293700
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: