| Antonio M. Diaz Jr Mdpa Inc. | |
|
864 Central Blvd. Ste. #100 Brownsville TX 78520-7551 | |
| (956) 541-5231 | |
| (956) 541-3230 |
| Full Name | Antonio M. Diaz Jr Mdpa Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 864 Central Blvd., Brownsville, Texas |
| Authorized Official Name and Position | Ericka Parra (OFFICE MANAGER) |
| Authorized Official Contact | 9565415231 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Antonio M. Diaz Jr Mdpa Inc. P.o. Box 4119 Brownsville TX 78523-4119 Ph: (956) 541-5231 | Antonio M. Diaz Jr Mdpa Inc. 864 Central Blvd. Ste. #100 Brownsville TX 78520-7551 Ph: (956) 541-5231 |
| NPI Number | 1386796258 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 03/02/2012 |
| Medicare PECOS PAC ID | 6608031612 |
|---|---|
| Medicare Enrollment ID | O20120625000648 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386796258 | NPI | - | NPPES |
| 116040001 | Medicaid | TX | |
| 1160400-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | E5508 (Texas) | Primary |
| 305R00000X | Preferred Provider Organization | E5508 (Texas) | Secondary |
| Provider Name | Antonio M Diaz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952582710 PECOS PAC ID: 1254408073 Enrollment ID: I20080922000112 |
| Provider Name | Valerie Annette Paniagua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609358779 PECOS PAC ID: 5799121364 Enrollment ID: I20240306002273 |
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