Provider Demographics
NPI:1225625601
Name:RODRIGUEZ-CHARLES, BERTMARIE (CCT)
Entity Type:Individual
Prefix:
First Name:BERTMARIE
Middle Name:
Last Name:RODRIGUEZ-CHARLES
Suffix:
Gender:F
Credentials:CCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N BENGE ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-2727
Mailing Address - Country:US
Mailing Address - Phone:469-793-9245
Mailing Address - Fax:
Practice Address - Street 1:604 N BENGE ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-2727
Practice Address - Country:US
Practice Address - Phone:469-793-9245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00090046246X00000X
246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00090046OtherCARDIOVASCULAR CREDENTIALING INTERNATIONAL