Provider Demographics
NPI:1629321054
Name:DIAZ, IRENE (OTR)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 JO DIN DR.
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542
Mailing Address - Country:US
Mailing Address - Phone:956-580-1100
Mailing Address - Fax:956-580-1138
Practice Address - Street 1:1315 W. MAIN A, SUITE 11
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573
Practice Address - Country:US
Practice Address - Phone:956-580-1100
Practice Address - Fax:956-580-1138
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115076225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist