MEDICARE: DIEGO BARBARA MIJARES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	T7491	TX
2	207V00000X	Obstetrics & Gynecology Physician	25MA10355800	NJ

General Provider Information

NPI Number	:	1134522634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIEGO BARBARA MIJARES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MEDICAL PKWY STE 310
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78738-1794
Country	:	US
Telephone Number	:	512-654-1234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	09/08/2022

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