Healthcare Provider Details

I. General information

NPI: 1467422881
Provider Name (Legal Business Name): ALEXANDRA SOFIA RODRIGUEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 CALLE YANGTZE RIO PIEDRAS HEIGHTS
SAN JUAN PR
00926-3152
US

IV. Provider business mailing address

MANSIONES DE GARDEN HILLS ST. #8 D-3
GUAYNABO PR
00966
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-5120
  • Fax:
Mailing address:
  • Phone: 787-782-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2410
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: