Provider Demographics
NPI:1477046878
Name:DIAZ ROJAS, JUAN SEBASTIAN (MD)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:SEBASTIAN
Last Name:DIAZ ROJAS
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 1:1120 NW 14TH STREET
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:786-539-6142
Mailing Address - Fax:902-700-5713
Practice Address - Street 1:1120 NW 14TH STREET
Practice Address - Street 2:SUITE 1300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:786-539-6142
Practice Address - Fax:902-700-5713
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2019-09-12
Deactivation Date:2019-01-25
Deactivation Code:
Reactivation Date:2019-09-12
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLTRN27274390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program