MEDICARE: DANIEL P DIAZ PHD

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	103TC0700X	Clinical Psychologist	25328	TX

General Provider Information

NPI Number	:	1477666410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL P DIAZ PHD

Provider Business Mailing Address
First Line	:	P.O. BOX 90974
Second Line	:	5701 BROADWAY STE 102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209
Country	:	US
Telephone Number	:	210-860-3685
Fax Number	:	210-680-3904

Provider Business Practice Location Address
First Line	:	5701 BROADWAY
Second Line	:	STE 102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209
Country	:	US
Telephone Number	:	210-860-3685
Fax Number	:	210-680-3904

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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