Provider Demographics
NPI:1902920614
Name:DIAZ-ROSARIO, LUIS ALONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALONSO
Last Name:DIAZ-ROSARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34852 FAIRVIEW HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-7745
Mailing Address - Country:US
Mailing Address - Phone:813-787-9585
Mailing Address - Fax:
Practice Address - Street 1:4225 E FOWLER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-2026
Practice Address - Country:US
Practice Address - Phone:813-972-7100
Practice Address - Fax:813-972-8267
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83032207ZP0102X
GA050356207ZP0102X
MA80068207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology