Healthcare Provider Details

I. General information

NPI: 1679610406
Provider Name (Legal Business Name): CLAUDIA DIAZ D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W HILDEBRAND AVE
SAN ANTONIO TX
78201-4609
US

IV. Provider business mailing address

7527 TANTARA CT
SAN ANTONIO TX
78249-3671
US

V. Phone/Fax

Practice location:
  • Phone: 210-733-9477
  • Fax: 210-733-9561
Mailing address:
  • Phone: 210-697-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22341
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: