Basic Information
| Provider Information | |||||||||
| NPI: | 1730463324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | ADOLFO | ||||||||
| MiddleName: | ENRIQUE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7703 FLOYD CURL DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104501143 | ||||||||
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| Practice Location | |||||||||
| Address1: | 720 PLEASANTON RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782141306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109213800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | P0374 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | P0374 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | P0374 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 288987504 | 01 | TX | CSHCN | OTHER | 288987503 | 05 | TX | MEDICAID |