Provider Demographics
NPI:1922165166
Name:RODRIGUEZ, CARMEN-GLORIA (WSC)
Entity Type:Individual
Prefix:MS
First Name:CARMEN-GLORIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:WSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 NE 30TH ST UNIT 901
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4312
Mailing Address - Country:US
Mailing Address - Phone:305-338-1658
Mailing Address - Fax:305-576-4234
Practice Address - Street 1:444 NE 30TH ST UNIT 901
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4312
Practice Address - Country:US
Practice Address - Phone:305-338-1658
Practice Address - Fax:305-576-4234
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage