Provider Demographics
NPI:1366588592
Name:PABLO, MARIA RHODORA SISON (RDH)
Entity type:Individual
Prefix:
First Name:MARIA RHODORA
Middle Name:SISON
Last Name:PABLO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ALCAZAR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1378
Mailing Address - Country:US
Mailing Address - Phone:805-925-3505
Mailing Address - Fax:
Practice Address - Street 1:30TH ADOS SGGD
Practice Address - Street 2:338 SOUTH DAKOTA AVE, STE 1-1300
Practice Address - City:VANDENBERG AFB
Practice Address - State:CA
Practice Address - Zip Code:93437-6317
Practice Address - Country:US
Practice Address - Phone:805-606-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22885124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist