Provider Demographics
NPI:1467271072
Name:RODRIGUEZ DIAZ, ROLANDO ERNESTO SR (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:ERNESTO
Last Name:RODRIGUEZ DIAZ
Suffix:SR
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 1:2621 BLVD LUIS A FERRE
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2106
Mailing Address - Country:US
Mailing Address - Phone:939-438-4757
Mailing Address - Fax:
Practice Address - Street 1:2621 BLVD LUIS A FERRE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2106
Practice Address - Country:US
Practice Address - Phone:939-438-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16915-I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice