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General NPI Number Information
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NPI Number | 1225345754
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Entity Type | Individual
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Provider Name | ANGELA J DIAZ DNP, FNP
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Gender | Female
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 3551 ROGER BROOKE DR
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-536-6339
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Fax |
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Provider Business Mailing Address
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Address Line | 8522 WILD TRCE
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City | GARDEN RIDGE
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State | TX
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Zip | 78266-2219
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Country | US
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Telephone | 210-240-5724
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 664616
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License Number State | TX
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