Provider Demographics
NPI:1356466403
Name:DIAZ, MARGARITA LEONOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:LEONOR
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10050 GREAT HILLS TRL
Mailing Address - Street 2:APT 706
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5938
Mailing Address - Country:US
Mailing Address - Phone:512-791-5081
Mailing Address - Fax:
Practice Address - Street 1:1011 W 31ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2099
Practice Address - Country:US
Practice Address - Phone:512-791-5081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31521103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB1063100Medicare UPIN