Provider Demographics
NPI:1851300891
Name:DIAZ, ROBERTO FABRICIO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:FABRICIO
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 1:7121 S PADRE ISLAND DR STE 104
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4939
Mailing Address - Country:US
Mailing Address - Phone:361-271-5221
Mailing Address - Fax:
Practice Address - Street 1:7121 S PADRE ISLAND DR STE 104
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4939
Practice Address - Country:US
Practice Address - Phone:361-271-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7943207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170710103Medicaid
TX873515088OtherTAX IDENTIFICATION NUMBER
TXTIN 202804321OtherTAX ID NUMBER
TX8F0483Medicare PIN