Provider Demographics
NPI:1912685025
Name:RODRIGUEZ, GADDI CRUZ
Entity Type:Individual
Prefix:
First Name:GADDI
Middle Name:CRUZ
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 ALLANWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1180
Mailing Address - Country:US
Mailing Address - Phone:301-844-1344
Mailing Address - Fax:
Practice Address - Street 1:9309 CENTER ST STE 101
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5599
Practice Address - Country:US
Practice Address - Phone:703-546-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health