Provider Demographics
NPI:1124660113
Name:RODRIGUEZ VEGA, NATTALI (DMD)
Entity type:Individual
Prefix:DR
First Name:NATTALI
Middle Name:
Last Name:RODRIGUEZ VEGA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 CAMINO DEL YUNQUE
Mailing Address - Street 2:URB SABANERA DORADO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-365-5226
Mailing Address - Fax:
Practice Address - Street 1:MANATI MEDICAL PLAZA
Practice Address - Street 2:SUITE 208
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3362122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist