Healthcare Provider Details

I. General information

NPI: 1306764709
Provider Name (Legal Business Name): GAYNELL NICOLE DODDS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 ELM DR
RODEO CA
94572-1702
US

IV. Provider business mailing address

836 ELM DR
RODEO CA
94572-1702
US

V. Phone/Fax

Practice location:
  • Phone: 510-932-3722
  • Fax:
Mailing address:
  • Phone: 510-932-3722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number95290186
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number95290186
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95290186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: