Provider Demographics
NPI:1104986553
Name:DIAZ-ARRASTIA, CONCEPCION RAVELO (MD)
Entity type:Individual
Prefix:MS
First Name:CONCEPCION
Middle Name:RAVELO
Last Name:DIAZ-ARRASTIA
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 1:1213 HERMANN DR STE 675
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7083
Mailing Address - Country:US
Mailing Address - Phone:713-756-8555
Mailing Address - Fax:713-756-8305
Practice Address - Street 1:1213 HERMANN DR STE 675
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7083
Practice Address - Country:US
Practice Address - Phone:713-756-8555
Practice Address - Fax:713-756-8305
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1651207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124926003Medicaid
TX124926003Medicaid
TX8L20121Medicare PIN
TX83377NMedicare ID - Type Unspecified