Provider Demographics
NPI:1336173368
Name:RODRIGUEZ, GLORIA ADRIANA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ADRIANA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S RAUL LONGORIA RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-5238
Mailing Address - Country:US
Mailing Address - Phone:956-381-4545
Mailing Address - Fax:956-381-4541
Practice Address - Street 1:709 S RAUL LONGORIA RD
Practice Address - Street 2:SUITE G
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-5238
Practice Address - Country:US
Practice Address - Phone:956-381-4545
Practice Address - Fax:956-381-4541
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110390225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159486307Medicaid
TX159486305Medicaid
TX159486308Medicaid
TX159486309Medicaid
TX159486310Medicaid
TX159486303Medicaid