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General NPI Number Information
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NPI Number | 1669106407
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Entity Type | Organization
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Legal Business Name | THE PORT OCCUPATIONAL & MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 20035 STATE HWY 48
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City | BROWNSVILLE
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State | TX
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Zip | 78521
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Country | US
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Telephone | 956-431-0452
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Fax | 956-431-0454
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Provider Business Mailing Address
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Address Line | 20035 STATE HWY 48
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City | BROWNSVILLE
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State | TX
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Zip | 78521
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Country | US
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Telephone | 956-431-0452
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Fax | 956-431-0454
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Authorized Official
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Title or Position | OWNER/MEDICAL DOCTOR
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Name | ANTONIO M DIAZ JR.
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Credential | MD
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Telephone | 956-252-4969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NULL
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