Provider Demographics
NPI:1942286901
Name:DIAZ, RICHARD P (FNP, APRN-BC; PMHNP)
Entity Type:Individual
Prefix:PROF
First Name:RICHARD
Middle Name:P
Last Name:DIAZ
Suffix:
Gender:M
Credentials:FNP, APRN-BC; PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4637
Mailing Address - Country:US
Mailing Address - Phone:210-324-3619
Mailing Address - Fax:
Practice Address - Street 1:6711 S NEW BRAUNFELS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3002
Practice Address - Country:US
Practice Address - Phone:210-531-8349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664132163W00000X
NY332221363LF0000X
NY475853163W00000X
TXAP113929363LP0808X, 363LF0000X
NY400612363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203619602OtherMEDICARE TPI
TX13927411OtherTEXAS CAQH
TX8L11629Medicare UPIN