Provider Demographics
NPI:1285454512
Name:RODRIGUEZ DIAZ, ALEJANDRO ABEL (APRN)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:ABEL
Last Name:RODRIGUEZ DIAZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22030 SW 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-4507
Mailing Address - Country:US
Mailing Address - Phone:786-379-7205
Mailing Address - Fax:
Practice Address - Street 1:22030 SW 122ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-4507
Practice Address - Country:US
Practice Address - Phone:786-379-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11035714363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner