Provider Demographics
NPI:1336179985
Name:DIAZ, ROLANDO ELIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:ELIO
Last Name: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 1:4141 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2057
Mailing Address - Country:US
Mailing Address - Phone:305-442-1740
Mailing Address - Fax:305-442-2207
Practice Address - Street 1:11865 CORAL WAY STE B7
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2441
Practice Address - Country:US
Practice Address - Phone:305-220-6128
Practice Address - Fax:305-227-2855
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15857208000000X
FLME95472208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME95472OtherMEDICAL LICENSE
FLME95472OtherMEDICAL LICENSE