Provider Demographics
NPI:1922197417
Name:ARTEAGA, DIANA LEE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LEE
Last Name:ARTEAGA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HUDSPETH AVENUE
Mailing Address - Street 2:A
Mailing Address - City:SONORA
Mailing Address - State:TX
Mailing Address - Zip Code:76950
Mailing Address - Country:US
Mailing Address - Phone:325-387-6557
Mailing Address - Fax:325-387-5272
Practice Address - Street 1:301 HUDSPETH AVENUE
Practice Address - Street 2:A
Practice Address - City:SONORA
Practice Address - State:TX
Practice Address - Zip Code:76950
Practice Address - Country:US
Practice Address - Phone:325-387-6557
Practice Address - Fax:325-387-5272
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03978363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant