Healthcare Provider Details

I. General information

NPI: 1134378714
Provider Name (Legal Business Name): LAURA R. RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 S EVANS
UVALDE TX
78801-6034
US

IV. Provider business mailing address

908 S. EVANS ST
UVALDE TX
78801-6034
US

V. Phone/Fax

Practice location:
  • Phone: 830-278-3765
  • Fax: 830-278-3373
Mailing address:
  • Phone: 830-278-5604
  • Fax: 830-278-1836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0014682
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: