Provider Demographics
NPI:1083844617
Name:DIAZ, ROLANDO JAVIER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:JAVIER
Last Name:DIAZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 FORT MYER DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-3113
Mailing Address - Country:US
Mailing Address - Phone:703-761-3100
Mailing Address - Fax:703-528-7507
Practice Address - Street 1:1655 N FORT MYER DR
Practice Address - Street 2:SUITE 350
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-3113
Practice Address - Country:US
Practice Address - Phone:703-761-3100
Practice Address - Fax:703-528-7507
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810-002621103TC0700X
DCPSY1000011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical