Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 6080 | NV |
NPI | 1356437339 |
---|---|
Provider Name | Dr. Gerardo David Rodriguez |
First Address | Reno, NV 89502-1702 |
Second Address | Reno, NV 89502-1702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 20/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002016388 | (05) | NV |
CC9393 | BCBS (01) | NV |
E82107 | (02) |