Provider Demographics
NPI:1154450989
Name:RODRIGUEZ, GINA LUCY (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:LUCY
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:LUCILA
Other - Last Name:RODRIGUEZ-MAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:77 BIRCH ST STE B
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1400
Mailing Address - Country:US
Mailing Address - Phone:650-363-6161
Mailing Address - Fax:650-363-9311
Practice Address - Street 1:77 BIRCH ST STE B
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1400
Practice Address - Country:US
Practice Address - Phone:650-363-6161
Practice Address - Fax:650-363-9311
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43050208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C430501Medicaid