Provider Demographics
NPI:1487033031
Name:DIAZ RODRIGUEZ, CARLOS MARKOVITCH (SA-C)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MARKOVITCH
Last Name:DIAZ RODRIGUEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10587 W 33RD CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2115
Mailing Address - Country:US
Mailing Address - Phone:786-328-5996
Mailing Address - Fax:
Practice Address - Street 1:10587 W 33RD CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-2115
Practice Address - Country:US
Practice Address - Phone:786-328-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-124246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant