Healthcare Provider Details

I. General information

NPI: 1831690817
Provider Name (Legal Business Name): ELISA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 SILVER SPRINGS DR BLDG 6A
EL PASO TX
79912-4126
US

IV. Provider business mailing address

9314 RYDER DR
SAN ANTONIO TX
78254-2000
US

V. Phone/Fax

Practice location:
  • Phone: 915-219-4222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: