Healthcare Provider Details

I. General information

NPI: 1417325358
Provider Name (Legal Business Name): ROLANDO DIAZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 N CENTRAL AVE STE 1600 SUITE 1600
PHOENIX AZ
85004-4633
US

IV. Provider business mailing address

1850 N CENTRAL AVE STE 1600 SUITE 1600
PHOENIX AZ
85004-4633
US

V. Phone/Fax

Practice location:
  • Phone: 602-262-8900
  • Fax: 602-262-8890
Mailing address:
  • Phone: 602-262-8900
  • Fax: 602-262-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1162
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: