Individual provider Active NPI

Mayra Luz Rodriguez, D.M.D

  • General Practice Dentistry
  • Boca Raton, FL
National Provider Identifier
1972703254
Registry record updated Oct 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN18010 Issued in FL
Practice address
23082 Sandalfoot Plaza Dr
Boca Raton, FL 33428-6654
Phone
(561) 953-9393
Fax
(561) 684-6564
NPI assigned
Jul 24, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN18010 FL Primary

Addresses

Primary practice location

23082 Sandalfoot Plaza Dr
Boca Raton, FL 33428-6654

Mailing address

23082 Sandalfoot Plaza Dr
Boca Raton, FL 33428-6654
Phone (561) 953-9393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN18010FLMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444867200000",
    "number": "1972703254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23082 SANDALFOOT PLAZA DR",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334286654",
            "telephone_number": "561-953-9393",
            "fax_number": "561-684-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23082 SANDALFOOT PLAZA DR",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334286654",
            "telephone_number": "561-953-9393",
            "fax_number": "561-684-6564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "MAYRA",
        "middle_name": "LUZ",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-24",
        "last_updated": "2015-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN18010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.