Healthcare Provider Details

I. General information

NPI: 1003919689
Provider Name (Legal Business Name): SONIA GARZA RODRIGUEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E BUSTAMANTE ST SUITE F
LAREDO TX
78041
US

IV. Provider business mailing address

1501 E BUSTAMANTE ST SUITE F
LAREDO TX
78041
US

V. Phone/Fax

Practice location:
  • Phone: 956-717-9100
  • Fax: 956-717-5900
Mailing address:
  • Phone: 956-717-9100
  • Fax: 956-717-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15618
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: