Healthcare Provider Details

I. General information

NPI: 1144894445
Provider Name (Legal Business Name): IVETTE GONZALEZ-DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 ALAMEDA AVE
EL PASO TX
79905-2702
US

IV. Provider business mailing address

4801 ALBERTA AVE
EL PASO TX
79905-2707
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-5850
  • Fax: 915-215-8657
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberW5353
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: