Provider Demographics
NPI:1245798602
Name:LOERA DIAZ, SAMUEL (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:LOERA DIAZ
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 CLONMORE CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4016
Mailing Address - Country:US
Mailing Address - Phone:909-254-3276
Mailing Address - Fax:
Practice Address - Street 1:1143 CLONMORE CT
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4016
Practice Address - Country:US
Practice Address - Phone:909-254-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant