Healthcare Provider Details

I. General information

NPI: 1578553764
Provider Name (Legal Business Name): JOSE ANDRES DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N SAN SABA STE 206
SAN ANTONIO TX
78207-3120
US

IV. Provider business mailing address

PO BOX 504152
SAINT LOUIS MO
63150-4152
US

V. Phone/Fax

Practice location:
  • Phone: 210-477-3271
  • Fax: 210-477-3274
Mailing address:
  • Phone: 210-212-8622
  • Fax: 210-212-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberK9050
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberK9050
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: