Provider Demographics
NPI:1912485996
Name:DIAZ, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 JAY AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3921
Mailing Address - Country:US
Mailing Address - Phone:956-331-5955
Mailing Address - Fax:956-306-6777
Practice Address - Street 1:2100 JAY AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3921
Practice Address - Country:US
Practice Address - Phone:956-331-5955
Practice Address - Fax:956-306-6777
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TX986031163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163W00000XNursing Service ProvidersRegistered Nurse