1316061377 NPI number — CARLOS JAVIER DIAZ VELEZ MD

Table of content: CARLOS JAVIER DIAZ VELEZ MD (NPI 1316061377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316061377 NPI number — CARLOS JAVIER DIAZ VELEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ VELEZ
Provider First Name:
CARLOS
Provider Middle Name:
JAVIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316061377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 781616
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78278-1616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-558-6288
Provider Business Mailing Address Fax Number:
210-558-6289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4085 DE ZAVALA RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAVANO PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78249-2084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-558-6288
Provider Business Practice Location Address Fax Number:
210-558-6289
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  N0732 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 196858803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196858801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196858802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com