Healthcare Provider Details

I. General information

NPI: 1659330900
Provider Name (Legal Business Name): RODRIGO DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE FD ROOSEVET 400 SUITE 304
HATO REY PR
00918
US

IV. Provider business mailing address

400 AVE FD ROOSEVELT SUITE 304
SAN JUAN PR
00918-2130
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-7406
  • Fax: 787-753-0054
Mailing address:
  • Phone: 787-753-7406
  • Fax: 787-753-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number11301
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: