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Individual

GWENDOLYN RODRIGUEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRANIAL PROSTHETIC

Contact information

Practice address
808 CIRCLEWOOD DR, RICHMOND, VA 23224-1604
(804) 325-0096
(804) 325-0096
Mailing address
808 CIRCLEWOOD DR, RICHMOND, VA 23224-1604
(804) 325-0096

Taxonomy

Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
1204017518
VA
332BC3200X
Customized Equipment (DME)
22RO00331168
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1720185762
VA
Enumeration date
11/27/2017
Last updated
03/17/2018
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