Provider Demographics
NPI:1790543734
Name:GASCON DIAZ, RODSANA
Entity Type:Individual
Prefix:
First Name:RODSANA
Middle Name:
Last Name:GASCON DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 SW 129TH PL APT 108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2110
Mailing Address - Country:US
Mailing Address - Phone:786-803-2593
Mailing Address - Fax:
Practice Address - Street 1:810 SW 129TH PL APT 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2110
Practice Address - Country:US
Practice Address - Phone:786-803-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF03240253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily