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General NPI Number Information
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NPI Number | 1326338179
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Entity Type | Individual
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Provider Name | MIREYA RODRIGUEZ-ELICEA RDHAP
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Gender | Female
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 10950 CHURCH ST APT 3416
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8095
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Country | US
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Telephone | 909-374-2493
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Fax |
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Provider Business Mailing Address
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Address Line | 17995 LACEBARK CT
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-0531
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Country | US
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Telephone | 909-374-2493
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 342
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License Number State | CA
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