Provider Demographics
NPI:1972584407
Name:DIAZ-ROHENA, ROBERTO (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:DIAZ-ROHENA
Suffix:
Gender:M
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:PO BOX 531848
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1848
Mailing Address - Country:US
Mailing Address - Phone:956-631-8875
Mailing Address - Fax:956-682-6280
Practice Address - Street 1:1309 E RIDGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1517
Practice Address - Country:US
Practice Address - Phone:956-631-8875
Practice Address - Fax:956-682-6280
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4775207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137745912Medicaid
TX8D4591Medicare ID - Type Unspecified
TX137745912Medicaid