Provider Demographics
NPI:1619137700
Name:DIEGUEZ-ARSENAULT, JESSIE ANGELICA (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:ANGELICA
Last Name:DIEGUEZ-ARSENAULT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79103-2700
Mailing Address - Country:US
Mailing Address - Phone:806-374-7341
Mailing Address - Fax:806-322-0533
Practice Address - Street 1:3113 ROSS ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79103-2700
Practice Address - Country:US
Practice Address - Phone:806-374-7341
Practice Address - Fax:806-322-0533
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111039208000000X
TXQ0429208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1087467Medicaid