Provider Demographics
NPI:1619378171
Name:DIAZ-HERNANDEZ, SANDRA (RD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:DIAZ-HERNANDEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 RAPHAEL DR.
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-362-5673
Mailing Address - Fax:956-362-2038
Practice Address - Street 1:5500 RAPHAEL DR.
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-362-5673
Practice Address - Fax:956-362-2038
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83433133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344862301Medicaid
TX384462YZRCMedicare PIN