MEDICARE: MARIA RHODORA SISON PABLO RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	22885	CA

General Provider Information

NPI Number	:	1366588592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA RHODORA SISON PABLO RDH

Provider Business Mailing Address
First Line	:	303 ALCAZAR DR
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1378
Country	:	US
Telephone Number	:	805-925-3505
Fax Number	:

Provider Business Practice Location Address
First Line	:	30TH ADOS SGGD
Second Line	:	338 SOUTH DAKOTA AVE, STE 1-1300
City	:	VANDENBERG AFB
State	:	CA
Zip	:	93437-6317
Country	:	US
Telephone Number	:	805-606-1846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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