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General NPI Number Information
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NPI Number | 1598001323
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Entity Type | Organization
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Legal Business Name | HEART CONSULTANTS OF SAN ANTONIO, PLLC
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 1201 S MAIN ST SUITE 209
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City | BOERNE
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State | TX
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Zip | 78006-2833
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Country | US
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Telephone | 210-385-2624
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Fax | 830-249-1195
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Provider Business Mailing Address
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Address Line | 343 W HOUSTON ST SUITE 211
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2107
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Country | US
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Telephone | 210-229-1980
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Fax | 210-229-1989
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE A DIAZ-WIDMANN
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Credential | MD
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Telephone | 210-229-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | K9050
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License Number State | TX
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