Provider Demographics
NPI:1740423474
Name:DIAZ, SERGIO (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
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 1:110 E SAVANNAH AVE BLDG A204
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1239
Mailing Address - Country:US
Mailing Address - Phone:956-686-4040
Mailing Address - Fax:956-630-6088
Practice Address - Street 1:110 E SAVANNAH AVE BLDG A204
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1239
Practice Address - Country:US
Practice Address - Phone:956-686-4040
Practice Address - Fax:956-630-6088
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXPA04894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine