MEDICARE: ROBERTO DIAZ D.D.S. P.A.

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	1223G0001X	General Practice Dentistry	13449	TX

General Provider Information

NPI Number	:	1619042793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTO DIAZ D.D.S. P.A.

Provider Business Mailing Address
First Line	:	1501 W SAM HOUSTON ST
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-5111
Country	:	US
Telephone Number	:	956-781-5477
Fax Number	:	956-781-4878

Provider Business Practice Location Address
First Line	:	1501 W SAM HOUSTON ST
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-5111
Country	:	US
Telephone Number	:	956-781-5477
Fax Number	:	956-781-4878

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERTO DIAZ
Credential	:	D.D.S.
Telephone Number	:	956-781-5477

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	08/22/2020

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