=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487074050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. DIAGNE PREMIER OB GYN PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2014
-----------------------------------------------------
Last Update Date | 04/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4422 S MCCOLL RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-9608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-800-4378
-----------------------------------------------------
Fax | 956-800-4379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3217
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78502-3217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-800-4378
-----------------------------------------------------
Fax | 956-800-4379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING CREDENTIALING OFIICER
-----------------------------------------------------
Name | MRS. SUEHAYNEE CAVAZOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-205-3630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------