MEDICARE: VICTOR DIAZ JR.

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	367H00000X	Anesthesiologist Assistant		TX

General Provider Information

NPI Number	:	1770449654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR DIAZ JR.

Provider Business Mailing Address
First Line	:	11977 CANNON HILL DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-0355
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11977 CANNON HILL DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-0355
Country	:	US
Telephone Number	:	915-703-9183
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	05/04/2026

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Directions to “ VICTOR DIAZ JR. ” Practice Location

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