1740404862 NPI number — THELMA E DIAZ NP

Table of content: THELMA E DIAZ NP (NPI 1740404862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740404862 NPI number — THELMA E DIAZ NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ
Provider First Name:
THELMA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740404862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1626 MEDICAL CENTER DR STE 400
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79902-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-546-9200
Provider Business Mailing Address Fax Number:
915-546-9800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1626 MEDICAL CENTER DR STE 400
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-546-9200
Provider Business Practice Location Address Fax Number:
915-546-9800
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WW0000X , with the licence number:  AP107026 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207PE0005X , with the licence number: AP107026 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 584935 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 189774601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 189774603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 189774602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 189774604 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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