Healthcare Provider Details

I. General information

NPI: 1336179985
Provider Name (Legal Business Name): ROLANDO ELIO DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9722 SW 184TH ST
CUTLER BAY FL
33157-6987
US

IV. Provider business mailing address

4141 SW 6TH ST
CORAL GABLES FL
33134-2057
US

V. Phone/Fax

Practice location:
  • Phone: 786-429-3312
  • Fax: 786-250-3390
Mailing address:
  • Phone: 305-442-1740
  • Fax: 305-442-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15857
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME95472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: