Provider Demographics
NPI:1184686289
Name:DIAZ, ROLANDO (MD)
Entity Type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 LAS AMERICAS AVENUE CONSTANCIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2106
Mailing Address - Country:US
Mailing Address - Phone:787-840-2838
Mailing Address - Fax:787-840-2838
Practice Address - Street 1:CALLE LA CRUZ #6
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-837-2265
Practice Address - Fax:787-260-1441
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14422208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21468DIOtherTRIPLE S
PR2011355OtherPREFERRED HEALTH
OR3114422OtherUIA
PR7950022OtherHUMANA INSURANCE AND HEAL
OR3114422OtherUIA
PR21468Medicare ID - Type Unspecified