Provider Demographics
NPI:1114340858
Name:DIAZ TORRUELLAS, ROSALY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ROSALY
Middle Name:MARIE
Last Name:DIAZ TORRUELLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W CHARLESTON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1965
Mailing Address - Country:US
Mailing Address - Phone:787-550-9188
Mailing Address - Fax:
Practice Address - Street 1:2801 W CHARLESTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1965
Practice Address - Country:US
Practice Address - Phone:702-659-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17739207R00000X
NV17739208M00000X
NV17070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1114340858Medicaid
NVV50700OtherSMA MEDICARE