Provider Demographics
NPI:1235856147
Name:COLON RODRIGUEZ, CHARLIE OBERT
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:OBERT
Last Name:COLON RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SPRINGVIEW DR
Mailing Address - Street 2:SANDFORD, FL 32773
Mailing Address - City:SANDFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773
Mailing Address - Country:US
Mailing Address - Phone:787-685-9113
Mailing Address - Fax:
Practice Address - Street 1:2980 PARK POND WAY FL 34741
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7660
Practice Address - Country:US
Practice Address - Phone:407-930-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health