Basic Information
| Provider Information | |||||||||
| NPI: | 1336179985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | ROLANDO | ||||||||
| MiddleName: | ELIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4141 SW 6TH ST | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331342057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054421740 | ||||||||
| FaxNumber: | 3054422207 | ||||||||
| Practice Location | |||||||||
| Address1: | 11865 CORAL WAY STE B7 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331752441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052206128 | ||||||||
| FaxNumber: | 3052272855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 08/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 15857 | PR | N | Allopathic & Osteopathic Physicians | Pediatrics | 208D00000X | ME95472 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | ME95472 | 01 | FL | MEDICAL LICENSE | OTHER |