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General NPI Number Information
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NPI Number | 1083844617
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Entity Type | Individual
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Provider Name | ROLANDO JAVIER DIAZ PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 1655 N FORT MYER DR SUITE 350
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City | ARLINGTON
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State | VA
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Zip | 22209-3113
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Country | US
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Telephone | 703-761-3100
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Fax | 703-528-7507
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Provider Business Mailing Address
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Address Line | 1655 FORT MYER DR SUITE 350
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City | ARLINGTON
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State | VA
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Zip | 22209-3113
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Country | US
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Telephone | 703-761-3100
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Fax | 703-528-7507
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810-002621
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY1000011
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License Number State | DC
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