Provider Demographics
NPI:1619217387
Name:OFILI, DIANE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:
Last Name:OFILI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1601
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-5141
Mailing Address - Fax:713-790-6859
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1601
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-5141
Practice Address - Fax:713-790-6859
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030707363AM0700X
TXPA09031363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8062NXOtherBCBS
TX358359302Medicaid
TX8062NXOtherBCBS