Provider Demographics
NPI:1235394271
Name:RODRIGUEZ, GLORY E (RD)
Entity Type:Individual
Prefix:MS
First Name:GLORY
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10754 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:UM
Mailing Address - Phone:787-559-6617
Mailing Address - Fax:
Practice Address - Street 1:8330 LYNDON B JOHNSON FWY STE B650
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1166
Practice Address - Country:US
Practice Address - Phone:469-619-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR896265133V00000X
PR1311133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered