Healthcare Provider Details

I. General information

NPI: 1497384051
Provider Name (Legal Business Name): ANDRES DIOCARES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 9TH AVE
TRUTH OR CONSEQUENCES NM
87901-1954
US

IV. Provider business mailing address

800 E 9TH AVE
TRUTH OR CONSEQUENCES NM
87901-1954
US

V. Phone/Fax

Practice location:
  • Phone: 575-894-3221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2024-0783
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberV1071
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: