Provider Demographics
NPI:1194535070
Name:RODRIGUEZ, CAROLINE YAMILE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:YAMILE
Last Name:RODRIGUEZ
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 1:20025 LAKE FOREST DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8716
Mailing Address - Country:US
Mailing Address - Phone:949-521-4907
Mailing Address - Fax:
Practice Address - Street 1:20025 LAKE FOREST DR STE 105
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8716
Practice Address - Country:US
Practice Address - Phone:949-521-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1111551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice