Individual
DIANA CARRASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
750 8TH AVE STE 20, FORT WORTH, TX 76104-2515
(682) 885-2170
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-2170
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
R9583
TX
208000000X
Pediatrics Physician
R9583
TX
Other
Enumeration date
03/27/2015
Last updated
04/13/2021
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