Provider Demographics
NPI:1639230048
Name:DIAZ FAMILY MEDICINE CLINIC PA
Entity type:Organization
Organization Name:DIAZ FAMILY MEDICINE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-812-1846
Mailing Address - Street 1:5510 ATASCOCITA ROAD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77346
Mailing Address - Country:US
Mailing Address - Phone:281-812-1846
Mailing Address - Fax:281-812-2778
Practice Address - Street 1:5510 ATASCOCITA ROAD
Practice Address - Street 2:SUITE 260
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346
Practice Address - Country:US
Practice Address - Phone:281-812-1846
Practice Address - Fax:281-812-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1831187004OtherINDIVIDUAL PROVIDERS NPI
TX00X638Medicare PIN
TXH62967Medicare UPIN
TX8F5090Medicare PIN