Provider Demographics
NPI:1548785488
Name:DIAZ RODRIGUEZ, KEILA MILAGROS (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KEILA
Middle Name:MILAGROS
Last Name:DIAZ RODRIGUEZ
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:KEILA
Other - Middle Name:
Other - Last Name:DIAZ-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8095
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 AVE LAUREL
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4816
Practice Address - Country:US
Practice Address - Phone:787-787-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19768207R00000X, 208D00000X
FLME154185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice