Provider Demographics
NPI:1922410422
Name:J. JESUS DIAZ M.D., P.A
Entity Type:Organization
Organization Name:J. JESUS DIAZ M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-759-1641
Mailing Address - Street 1:2101 CRAWFORD ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8942
Mailing Address - Country:US
Mailing Address - Phone:713-759-1641
Mailing Address - Fax:
Practice Address - Street 1:2101 CRAWFORD ST
Practice Address - Street 2:SUITE 208
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8942
Practice Address - Country:US
Practice Address - Phone:713-759-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121529503Medicaid
TX121529501Medicaid
TX121529503Medicaid