Healthcare Provider Details

I. General information

NPI: 1710612676
Provider Name (Legal Business Name): MRS. SARAH LEE DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 07/23/2022
Certification Date: 07/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S COULTER ST
AMARILLO TX
79106-1836
US

IV. Provider business mailing address

7725 PINNACLE DR
AMARILLO TX
79119-7495
US

V. Phone/Fax

Practice location:
  • Phone: 806-468-9700
  • Fax:
Mailing address:
  • Phone: 806-881-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1088297
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: