Gwendolyn Rodriguez, CRANIAL PROSTHETIC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

1204017518 Issued in VA

Practice address

808 Circlewood Dr
Richmond, VA 23224-1604

Phone

(804) 325-0096

Fax

(804) 325-0096

NPI assigned

Nov 27, 2017

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1511740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1760996938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 CIRCLEWOOD DR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232241604",
            "telephone_number": "804-325-0096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 CIRCLEWOOD DR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232241604",
            "telephone_number": "804-325-0096",
            "fax_number": "804-325-0096"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10101 Brook Rd",
            "address_purpose": "LOCATION",
            "city": "Glen Allen",
            "state": "VA",
            "postal_code": "230594225",
            "country_code": "US",
            "telephone_number": "804-325-0096",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "GWENDOLYN",
        "credential": "CRANIAL PROSTHETIC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-27",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NY",
            "license": "22RO00331168",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "VA",
            "license": "1204017518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720185762",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joe John Rodriguez Ayala, M.D.
• Daniel Bristol Rodriguez
• Daniella Rodriguez
• Diana Marcela Rodriguez, CRNA
• Elayne M Rodriguez
• Luis Alexander Rodriguez
• Oscar Rodriguez, RDH
• Ramon Rodriguez III, M.D., J.D.
• Kayla Marie Roe, DDS
• Tracy R. Roe, M.D.

• Customized Equipment (DME) in Richmond, VA
• Providers in Richmond, VA by specialty
• Customized Equipment (DME) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.