MEDICARE: MRS. WANDA M AYMAT RODRIQUEZ DMD

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	1223E0200X	Endodontics	2306	PR

General Provider Information

NPI Number	:	1831195064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WANDA M AYMAT RODRIQUEZ DMD

Provider Business Mailing Address
First Line	:	VIAS PASEO SOL #40
Second Line	:	200 BLVD DE LA FUENTE
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5988
Country	:	US
Telephone Number	:	787-855-3996
Fax Number	:	787-855-4346

Provider Business Practice Location Address
First Line	:	BETANCES 38B
Second Line	:
City	:	VEGA BAJA
State	:	PR
Zip	:	00693-4308
Country	:	US
Telephone Number	:	787-855-3996
Fax Number	:	787-855-4346

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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