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General NPI Number Information
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NPI Number | 1487227385
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Entity Type | Organization
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Legal Business Name | EILEEN VAN DIEST, MD, PA
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Dates
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Enumeration Date | 07/20/2021
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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 | 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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Authorized Official
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Title or Position | PHYSICIAN
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Name | EILEEN VAN DIEST
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Credential | MD
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Telephone | 830-219-4162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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