Provider Demographics
NPI:1366108110
Name:ROBERTO F. DIAZ, M.D., P.A.
Entity type:Organization
Organization Name:ROBERTO F. DIAZ, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:F
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-271-5221
Mailing Address - Street 1:5529 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2749
Mailing Address - Country:US
Mailing Address - Phone:361-701-0871
Mailing Address - Fax:
Practice Address - Street 1:7121 S PADRE ISLAND DR STE 104
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4939
Practice Address - Country:US
Practice Address - Phone:361-271-5221
Practice Address - Fax:361-444-5172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170710103Medicaid