Provider Demographics
NPI:1275764409
Name:RODRIGUEZ, CARLOS RUBEN (MA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:RUBEN
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 N HOAGLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-931-2911
Mailing Address - Fax:407-931-2711
Practice Address - Street 1:804 N. HOAGLAND BLVD.
Practice Address - Street 2:
Practice Address - City:KISSSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:32751
Practice Address - Country:US
Practice Address - Phone:407-931-2911
Practice Address - Fax:407-931-2711
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor