Provider Demographics
NPI:1174246961
Name:RODRIGUEZ, GABRIELLA ROSARIO
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ROSARIO
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 1:6817 GRUBBY RD
Mailing Address - Street 2:
Mailing Address - City:WILSONS
Mailing Address - State:VA
Mailing Address - Zip Code:23894-2507
Mailing Address - Country:US
Mailing Address - Phone:915-742-9309
Mailing Address - Fax:
Practice Address - Street 1:21227 TORCH ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-742-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist