Healthcare Provider Details

I. General information

NPI: 1609519438
Provider Name (Legal Business Name): JESSICA MARCELA DAZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E 6TH ST STE 105
WESLACO TX
78596-6608
US

IV. Provider business mailing address

5650 WORTH PKWY APT 1110
SAN ANTONIO TX
78257-1501
US

V. Phone/Fax

Practice location:
  • Phone: 956-289-9473
  • Fax:
Mailing address:
  • Phone: 346-402-5167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: