Healthcare Provider Details

I. General information

NPI: 1376639328
Provider Name (Legal Business Name): BLANCA DIEZ NAHMIAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BLANCA DIEZ M.D.

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 NASA PKWY APT 19S
SEABROOK TX
77586-6552
US

IV. Provider business mailing address

4821 NASA PKWY APT 19S
SEABROOK TX
77586-6552
US

V. Phone/Fax

Practice location:
  • Phone: 281-881-0237
  • Fax: 281-333-2293
Mailing address:
  • Phone: 281-881-0237
  • Fax: 281-333-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG1261
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberG1261
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: