Provider Demographics
NPI:1235875105
Name:DIAZ ROSADO, MANUEL ANTONIO
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANTONIO
Last Name:DIAZ ROSADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MEDICAL CENTER ROAD, DARNALL ARMY MEDICAL CENTER
Mailing Address - Street 2:EMERGENCY MEDICINE, RESIDENCY CENTER
Mailing Address - City:FORT CAVAZOS
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-553-9089
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL CENTER ROAD, DARNALL ARMY MEDICAL CENTER
Practice Address - Street 2:EMERGENCY MEDICINE, RESIDENCY CENTER
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544-5060
Practice Address - Country:US
Practice Address - Phone:254-553-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10086842390200000X
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program