Provider Demographics
NPI:1811460579
Name:RODRIGUEZ, GLORIA ADRIANA (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ADRIANA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP, PMHNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9895 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-2956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 S MAIN ST STE 113
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2921
Practice Address - Country:US
Practice Address - Phone:575-294-5724
Practice Address - Fax:575-259-5088
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139887363LP2300X
NM79582363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care