Provider Demographics
NPI:1326043506
Name:DIAZ, MARIA DOLORES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DOLORES
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:DOLORES
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2855 GRAMERCY ST STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1697
Mailing Address - Country:US
Mailing Address - Phone:713-668-6828
Mailing Address - Fax:
Practice Address - Street 1:5614 E SAM HOUSTON PKWY N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3249
Practice Address - Country:US
Practice Address - Phone:713-678-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9200207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132333907Medicaid