MEDICARE: NITUNA DIANA DIAZ

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	237700000X	Hearing Instrument Specialist	80326	TX

General Provider Information

NPI Number	:	1609304021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NITUNA DIANA DIAZ

Provider Business Mailing Address
First Line	:	3824 N 30TH ST
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-1519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 E WACO DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76705-3207
Country	:	US
Telephone Number	:	254-717-8459
Fax Number	:

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

Provider Enumeration Date	:	05/30/2017
Last Update Date	:	05/30/2017

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Directions to “ NITUNA DIANA DIAZ ” Practice Location

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