Provider Demographics
NPI:1811046188
Name:DIAZ, VICTOR ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ALBERTO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11202 MARSEILLES LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2747
Mailing Address - Country:US
Mailing Address - Phone:713-826-6867
Mailing Address - Fax:713-783-6070
Practice Address - Street 1:6360 W SAM HOUSTON PKWY N
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-5164
Practice Address - Country:US
Practice Address - Phone:713-826-6867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y409Medicare PIN
TX8L22120Medicare UPIN