Provider Demographics
NPI:1497302087
Name:MONTEVERDE DIAZ, ROLANDO J (MD)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:J
Last Name:MONTEVERDE DIAZ
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 1:2001 W 68TH ST
Mailing Address - Street 2:ATTN: MEDICAL EDUCATION, SUITE 202
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-364-2107
Mailing Address - Fax:305-822-8347
Practice Address - Street 1:2001 W 68TH ST
Practice Address - Street 2:ATTN: MEDICAL EDUCATION, SUITE 202
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-364-2107
Practice Address - Fax:305-822-8347
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD98727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty