=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306828041
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YVONNE DIAZ O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2005
-----------------------------------------------------
Last Update Date | 10/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8001 N 10TH ST STE 140
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-9490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-200-2020
-----------------------------------------------------
Fax | 956-340-4278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8001 N 10TH ST STE 140
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-9490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-200-2020
-----------------------------------------------------
Fax | 956-340-4278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4965TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------