Provider Demographics
NPI:1508146820
Name:DIAZ-RODRIGUEZ, VICTOR MANUEL (RRT)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:MANUEL
Last Name:DIAZ-RODRIGUEZ
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:211 POMEROY AVE
Mailing Address - Street 2:APT 1116
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7165
Mailing Address - Country:US
Mailing Address - Phone:719-588-9087
Mailing Address - Fax:
Practice Address - Street 1:211 POMEROY AVE
Practice Address - Street 2:APT 1116
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-7165
Practice Address - Country:US
Practice Address - Phone:719-588-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0117001499227900000X
TX67341227900000X
CT001421227900000X
CO2943227900000X
MO2011013988227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered