Provider Demographics
NPI:1457328817
Name:RODRIGUEZ DIAZ, LUIS E (CRNA)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:RODRIGUEZ DIAZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:EMILIO
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1900 PURDY AVE APT 2209
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1495
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3001 W. DR. MARTIN LUTHER KING DRIVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-350-7244
Practice Address - Fax:813-350-7246
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9190432367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304879900Medicaid