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General NPI Number Information
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NPI Number | 1619507720
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Entity Type | Organization
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Legal Business Name | GONZALO A DIAZ
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 3030 JOE BATTLE BLVD
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City | EL PASO
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State | TX
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Zip | 79938-2667
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Country | US
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Telephone | 915-242-1634
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Fax | 915-242-1651
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Provider Business Mailing Address
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Address Line | 1016 QUINTA ANTIGUA LN
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City | EL PASO
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State | TX
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Zip | 79912-2039
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Country | US
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Telephone | 915-779-7378
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Fax | 915-779-2822
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Authorized Official
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Title or Position | PHYSICIAN/ OWNER
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Name | GONZALO A DIAZ
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Credential | MD
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Telephone | 915-779-7378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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