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Edith Avigail Gonzalez Rodriguez

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

903 W Martin St, San Antonio, TX 78207-0903

PECOS Enrollment

This provider is enrolled in PECOS as EDITH GONZALEZ RODRIGUEZ.

Based on the most recent information from CMS, provider Edith Avigail Gonzalez Rodriguez is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 9:43 AM.

Profile Details

Provider ID
1043170731
Provider Type
Individual
Full Name
Gonzalez Rodriguez, Edith Avigail
Credential
FNP-BC

Gender
Female
Sole Proprietor
No
Enumeration Date
11/14/2025
Last Updated
11/14/2025

Contact Information

Practice Location

903 W Martin St, San Antonio, TX 78207-0903

(210) 358-3400

Unlisted Fax

Mailing Location

5114 Medical Dr Apt 1111, San Antonio, TX 78229-3778

(512) 586-1220

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 1006115 Texas

Edith Avigail Gonzalez Rodriguez

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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