Provider Demographics
NPI:1992938849
Name:RODRIGUEZ, GRETCHEN JOSEFINA (MD)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:JOSEFINA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W BASS ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5001
Mailing Address - Country:US
Mailing Address - Phone:407-483-8801
Mailing Address - Fax:407-483-1298
Practice Address - Street 1:308 W BASS ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5001
Practice Address - Country:US
Practice Address - Phone:407-933-1760
Practice Address - Fax:407-933-8060
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17411208D00000X
FLACN936208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFR1766041OtherDEA