Provider Demographics
NPI:1043052061
Name:RODRIGUEZ ROLON, ANDREA S
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:S
Last Name:RODRIGUEZ ROLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 CALLE 38 SE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2636
Mailing Address - Country:US
Mailing Address - Phone:787-466-7289
Mailing Address - Fax:
Practice Address - Street 1:PASEO DR. CELSO BARBOSA TERRENO DE CENTRO MEDICO
Practice Address - Street 2:EDIFICIO PRINCIPAL RCM, PRIMER PISO
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR113R122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist