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General NPI Number Information
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NPI Number | 1356515217
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Entity Type | Individual
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Provider Name | EILEEN ELISABETH VAN DIEST M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 179 ENTERPRISE PKWY STE 102
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City | BOERNE
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State | TX
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Zip | 78006-8634
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Country | US
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Telephone | 830-219-4162
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Fax | 830-310-7974
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Provider Business Mailing Address
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Address Line | 32685 US HIGHWAY 281 N STE 181
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City | BULVERDE
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State | TX
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Zip | 78163-3271
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Country | US
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Telephone | 830-219-4162
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Fax | 830-310-7974
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M7978
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | M7978
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License Number State | TX
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