Provider Demographics
NPI:1427166644
Name:DIAZ, MARLENE (MD)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:DIAZ
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 1:3060 COMMUNICATIONS PKWY
Mailing Address - Street 2:STE 105
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8464
Mailing Address - Country:US
Mailing Address - Phone:972-535-8000
Mailing Address - Fax:
Practice Address - Street 1:3060 COMMUNICATIONS PKWY STE 105
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8464
Practice Address - Country:US
Practice Address - Phone:972-535-8000
Practice Address - Fax:972-403-8003
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1971174400000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ1971OtherSTATE MEDICAL LICENSE