MEDICARE: DR. ROLANDO JAVIER DIAZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810-002621	VA
2	103TC0700X	Clinical Psychologist	PSY1000011	DC

General Provider Information

NPI Number	:	1083844617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROLANDO JAVIER DIAZ PH.D.

Provider Business Mailing Address
First Line	:	1655 FORT MYER DR
Second Line	:	SUITE 350
City	:	ARLINGTON
State	:	VA
Zip	:	22209-3113
Country	:	US
Telephone Number	:	703-761-3100
Fax Number	:	703-528-7507

Provider Business Practice Location Address
First Line	:	1655 N FORT MYER DR
Second Line	:	SUITE 350
City	:	ARLINGTON
State	:	VA
Zip	:	22209-3113
Country	:	US
Telephone Number	:	703-761-3100
Fax Number	:	703-528-7507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	07/16/2009

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