Provider Demographics
NPI:1952406092
Name:DIAZ-VOGT, JOSEFINA A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:A
Last Name:DIAZ-VOGT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:STE. 120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-771-6558
Practice Address - Street 1:10525 VISTA DEL SOL DR
Practice Address - Street 2:STE. 200
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7944
Practice Address - Country:US
Practice Address - Phone:915-590-2535
Practice Address - Fax:915-590-2536
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK72742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144951402Medicaid
TX0044LBOtherBCBS
TX00912MMedicare PIN
H31715Medicare UPIN
TXP00124483Medicare PIN