Provider Demographics
NPI:1073067294
Name:DIAZ, MARISA D (PHD INTERN)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:D
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHD INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7618 GENTLE BEND DR.
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250
Mailing Address - Country:US
Mailing Address - Phone:210-862-0982
Mailing Address - Fax:
Practice Address - Street 1:343 LARCHMONT DR.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-867-9841
Practice Address - Fax:210-816-5900
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program