Provider Demographics
NPI:1912210139
Name:DIAMOND PROVIDER SERVICES INC
Entity Type:Organization
Organization Name:DIAMOND PROVIDER SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-461-6747
Mailing Address - Street 1:1001 E. BUS. HWY 83
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537
Mailing Address - Country:US
Mailing Address - Phone:956-461-6747
Mailing Address - Fax:956-461-6746
Practice Address - Street 1:1001 E. BUS. HWY 83
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537
Practice Address - Country:US
Practice Address - Phone:956-461-6747
Practice Address - Fax:956-461-6746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health