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General NPI Number Information
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NPI Number | 1831195064
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Entity Type | Individual
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Provider Name | WANDA M AYMAT RODRIQUEZ DMD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | BETANCES 38B
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City | VEGA BAJA
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State | PR
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Zip | 00693-4308
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Country | US
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Telephone | 787-855-3996
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Fax | 787-855-4346
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Provider Business Mailing Address
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Address Line | VIAS PASEO SOL #40 200 BLVD DE LA FUENTE
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City | SAN JUAN
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State | PR
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Zip | 00926-5988
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Country | US
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Telephone | 787-855-3996
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Fax | 787-855-4346
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2306
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License Number State | PR
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