Provider Demographics
NPI:1649302936
Name:DIAZ, MATEO IV (OTR)
Entity type:Individual
Prefix:MR
First Name:MATEO
Middle Name:
Last Name:DIAZ
Suffix:IV
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-3105
Mailing Address - Country:US
Mailing Address - Phone:956-565-9300
Mailing Address - Fax:956-565-9686
Practice Address - Street 1:327 WEST THIRD STREET
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570
Practice Address - Country:US
Practice Address - Phone:956-565-9300
Practice Address - Fax:956-565-9686
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109935225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist