Basic Information
| Provider Information | |||||||||
| NPI: | 1104200062 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAKAD-RODRIGUEZ | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 BILLINGSLEY RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282111009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044442400 | ||||||||
| FaxNumber: | 7043582516 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 BILLINGSLEY RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282111009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044442400 | ||||||||
| FaxNumber: | 7043582516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2015 | ||||||||
| LastUpdateDate: | 04/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 01160228596 | VA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 15306065000611 | 01 | VA | PECOS | OTHER |