Provider Demographics
NPI:1821110560
Name:DIEGO F. MENCHACA, M.D., P.A.
Entity Type:Organization
Organization Name:DIEGO F. MENCHACA, M.D., P.A.
Other - Org Name:DIEGO F. MENCHACA, M.D., P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:F
Authorized Official - Last Name:MENCHACA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-795-8300
Mailing Address - Street 1:1203 WELBY CT STE 2
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-1951
Mailing Address - Country:US
Mailing Address - Phone:956-795-8300
Mailing Address - Fax:956-795-8303
Practice Address - Street 1:1203 WELBY CT STE 2
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-1951
Practice Address - Country:US
Practice Address - Phone:956-795-8300
Practice Address - Fax:956-795-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4503261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150779001Medicaid
TX150779002Medicaid
TX150779001Medicaid
TX00353TMedicare PIN