Provider Demographics
NPI:1710972625
Name:DIAZ, PEDRO S (MD PA)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:S
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SARATOGA BLVD STE 480
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4103
Mailing Address - Country:US
Mailing Address - Phone:361-992-2300
Mailing Address - Fax:361-992-2305
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:SUITE 480
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4103
Practice Address - Country:US
Practice Address - Phone:361-992-2300
Practice Address - Fax:361-992-2305
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7889207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0976342-01Medicaid
TX0976342-01Medicare ID - Type Unspecified
TX0976342-01Medicaid