Provider Demographics
NPI:1356385355
Name:DIDIA, S CLAUDIA (MD)
Entity type:Individual
Prefix:
First Name:S
Middle Name:CLAUDIA
Last Name:DIDIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9520
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79995-9520
Mailing Address - Country:US
Mailing Address - Phone:915-215-4478
Mailing Address - Fax:915-545-5755
Practice Address - Street 1:4801 ALBERTA AVE.
Practice Address - Street 2:
Practice Address - City:EL )PASO
Practice Address - State:TX
Practice Address - Zip Code:79905
Practice Address - Country:US
Practice Address - Phone:915-215-4478
Practice Address - Fax:915-545-5755
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM5132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177968801Medicaid
TX8P0283OtherBCBS OF TEXAS
TXG89878Medicare UPIN
TXG89878Medicare UPIN