Provider Demographics
NPI:1659330900
Name:DIAZ, RODRIGO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 AVE FD ROOSEVELT
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2130
Mailing Address - Country:US
Mailing Address - Phone:787-753-7406
Mailing Address - Fax:787-753-0054
Practice Address - Street 1:AVE FD ROOSEVET 400
Practice Address - Street 2:SUITE 304
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-753-7406
Practice Address - Fax:787-753-0054
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11301207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF97838Medicare UPIN