Provider Demographics
NPI:1174282180
Name:DIAZ RODRIGUEZ, ANGEL XAVIER (RDN)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:XAVIER
Last Name:DIAZ RODRIGUEZ
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARCELAS JAUCA
Mailing Address - Street 2:#39
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-453-4347
Mailing Address - Fax:
Practice Address - Street 1:URB. PASEO COSTA DEL SUR
Practice Address - Street 2:R-16
Practice Address - City:AGUIRRE
Practice Address - State:PR
Practice Address - Zip Code:00704
Practice Address - Country:US
Practice Address - Phone:787-453-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered