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General NPI Number Information
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NPI Number | 1063054385
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Entity Type | Individual
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Provider Name | GABRIELA NICOLLE SANTIAGO RODRIGUEZ DMD
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Gender | Female
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 686 ST, VILLA REAL 1 A-1
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-858-5155
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1032
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City | VEGA ALTA
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State | PR
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Zip | 00692-1032
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Country | US
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Telephone | 787-412-2959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3334
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License Number State | PR
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