Provider Demographics
NPI:1477666410
Name:DIAZ, DANIEL P (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:DIAZ
Suffix:
Gender:M
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:P.O. BOX 90974
Mailing Address - Street 2:5701 BROADWAY STE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-860-3685
Mailing Address - Fax:210-680-3904
Practice Address - Street 1:5701 BROADWAY
Practice Address - Street 2:STE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-860-3685
Practice Address - Fax:210-680-3904
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25328103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00193CMedicare ID - Type Unspecified