MEDICARE: DR. JANICE MARIEL DIAZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZF0201X	Forensic Pathology Physician	263683	NY
2	207ZF0201X	Forensic Pathology Physician	Q0902	TX

General Provider Information

NPI Number	:	1245398916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANICE MARIEL DIAZ MD

Provider Business Mailing Address
First Line	:	4505 ALBERTA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905
Country	:	US
Telephone Number	:	915-532-1447
Fax Number	:

Provider Business Practice Location Address
First Line	:	4505 ALBERTA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-2727
Country	:	US
Telephone Number	:	915-532-1447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/26/2017

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