Provider Demographics
NPI:1306593116
Name:DIAZ, RAMIRO MIGUEL (PA-C)
Entity type:Individual
Prefix:
First Name:RAMIRO
Middle Name:MIGUEL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 SIERRA CT
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-1743
Mailing Address - Country:US
Mailing Address - Phone:956-862-2978
Mailing Address - Fax:
Practice Address - Street 1:900 W SAM HOUSTON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5215
Practice Address - Country:US
Practice Address - Phone:956-783-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant