Provider Demographics
NPI:1104311554
Name:RODRIGUEZ DIAZ, SORIANN MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:SORIANN
Middle Name:MICHELLE
Last Name:RODRIGUEZ DIAZ
Suffix:
Gender:F
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:AVENIDA 65 DE INFANTERIA KM 8 PR #3
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 2 KM. 141.1, AVE
Practice Address - Street 2:SEVERIANO CUEVAS 18
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-0000
Practice Address - Fax:787-658-0613
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR22045208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice