=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003919689
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONIA GARZA RODRIGUEZ DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 E BUSTAMANTE ST SUITE F
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-717-9100
-----------------------------------------------------
Fax | 956-717-5900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1501 E BUSTAMANTE ST SUITE F
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-717-9100
-----------------------------------------------------
Fax | 956-717-5900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 15618
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------