Individual
ROGER ALLEN DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
9440 VISCOUNT BLVD STE 100, EL PASO, TX 79925-7054
(915) 249-6639
(915) 249-6695
Mailing address
6401 PAGASA PL, EL PASO, TX 79932-2552
(915) 352-8176
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
852557
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP143739
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
852557
TEXAS BOARD OF NURSING LICENSE
TX
01
—
AP143739
TEXAS BOARD OF NURSING
TX
Enumeration date
04/23/2018
Last updated
10/29/2019
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