Healthcare Provider Details

I. General information

NPI: 1104311554
Provider Name (Legal Business Name): SORIANN MICHELLE RODRIGUEZ DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA ROBERTO CLEMENTE, CALLE 66 BLOQUE 124 #8 VILLA CAROLINA
CAROLINA PR
00985
US

IV. Provider business mailing address

AVE ROBERTO CLEMENTE CALLE 66, VILLA CAROLINA BLOQUE 124 #8
CAROLINA PR
00985
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-4920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number22045
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22045
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: