Provider Demographics
NPI:1639652068
Name:DIAZ, ROLANDO (APRN)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6100 BLUE LAGOON DR STE 365
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-7010
Mailing Address - Country:US
Mailing Address - Phone:786-322-7333
Mailing Address - Fax:786-347-5022
Practice Address - Street 1:1490 NW 27TH AVE STE 130
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2173
Practice Address - Country:US
Practice Address - Phone:305-635-7710
Practice Address - Fax:786-621-7817
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9243101363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9243101OtherARNP