Provider Demographics
NPI:1073154209
Name:DIAZ, ANGELICA (NP-C)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14207 REDBUD VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2156
Mailing Address - Country:US
Mailing Address - Phone:281-630-6102
Mailing Address - Fax:
Practice Address - Street 1:4710 BELLAIRE BLVD STE 340
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4530
Practice Address - Country:US
Practice Address - Phone:713-860-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144942363LF0000X
TX887268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse