Healthcare Provider Details

I. General information

NPI: 1245279447
Provider Name (Legal Business Name): GLORIA J RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 FAIRFAX DR STE 600
ARLINGTON VA
22203-1665
US

IV. Provider business mailing address

4250 FAIRFAX DR STE 600
ARLINGTON VA
22203-1665
US

V. Phone/Fax

Practice location:
  • Phone: 240-384-3442
  • Fax:
Mailing address:
  • Phone: 240-384-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101287623
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: