MEDICARE: LUIS NORBERTO DIAZ GONZALEZ

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	364SF0001X	Family Health Clinical Nurse Specialist	1085335	TX

General Provider Information

NPI Number	:	1538970835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS NORBERTO DIAZ GONZALEZ

Provider Business Mailing Address
First Line	:	20606 MAY DAWN DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-1967
Country	:	US
Telephone Number	:	786-230-7559
Fax Number	:

Provider Business Practice Location Address
First Line	:	20606 MAY DAWN DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-1967
Country	:	US
Telephone Number	:	786-230-7559
Fax Number	:

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

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	01/15/2025

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