Healthcare Provider Details

I. General information

NPI: 1487400370
Provider Name (Legal Business Name): CHARLOTTE LUXURY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 CRESCENT AVE
BRONX NY
10458-8220
US

IV. Provider business mailing address

1889 WEBSTER AVE
BRONX NY
10457-3246
US

V. Phone/Fax

Practice location:
  • Phone: 347-570-8918
  • Fax:
Mailing address:
  • Phone: 718-538-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO A RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 347-570-8918