Individual
DR. CHARLES L RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
329 NOKOMIS AVE S, STE M, VENICE, FL 34285-2418
(941) 800-4305
(941) 800-4963
Mailing address
329 NOKOMIS AVE S STE K&M, VENICE, FL 34285-2418
(941) 800-4305
(941) 800-4963
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
ME88067
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267751200
—
FL
01
—
71905
BCBS
FL
01
—
71905Y
PTAN
FL
01
—
P00072142
MEDICARE RR
FL
Enumeration date
08/22/2005
Last updated
02/07/2019
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