Provider Demographics
NPI:1356437339
Name:RODRIGUEZ, GERARDO DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:DAVID
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 RYLAND ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1702
Mailing Address - Country:US
Mailing Address - Phone:775-322-7272
Mailing Address - Fax:772-322-4789
Practice Address - Street 1:1190 RYLAND ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1702
Practice Address - Country:US
Practice Address - Phone:775-322-7272
Practice Address - Fax:772-322-4789
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV60802084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC9393OtherBCBS
NV002016388Medicaid
NVCC9393OtherBCBS