MEDICARE: DR. VICTOR ALBERTO 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	207Q00000X	Family Medicine Physician	J7468	TX

General Provider Information

NPI Number	:	1811046188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR ALBERTO DIAZ MD

Provider Business Mailing Address
First Line	:	11202 MARSEILLES LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2747
Country	:	US
Telephone Number	:	713-826-6867
Fax Number	:	713-783-6070

Provider Business Practice Location Address
First Line	:	6360 W SAM HOUSTON PKWY N
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77041-5164
Country	:	US
Telephone Number	:	713-826-6867
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	02/15/2010

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