Provider Demographics
NPI:1275762056
Name:DIAZ-ROZO, GABRIEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:D
Last Name:DIAZ-ROZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GABRIEL
Other - Middle Name:DEJESUS
Other - Last Name:DIAZ ROZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5130 SUNFOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:274-980-0067
Practice Address - Street 1:609 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1844
Practice Address - Country:US
Practice Address - Phone:727-824-0780
Practice Address - Fax:727-498-0006
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME114950OtherLICENSE NUMBER
FL009635200Medicaid
FL009635200Medicaid