Provider Demographics
NPI:1538740394
Name:DIAZ, GIANCARLO ANDRES (MD)
Entity type:Individual
Prefix:
First Name:GIANCARLO
Middle Name:ANDRES
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 ROANOKE RUN APT 303
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-5208
Mailing Address - Country:US
Mailing Address - Phone:830-513-9592
Mailing Address - Fax:
Practice Address - Street 1:1310 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5601
Practice Address - Country:US
Practice Address - Phone:210-757-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXW1774207L00000X
NY337699207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology