Basic Information
| Provider Information | |||||||||
| NPI: | 1487074050 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. DIAGNE PREMIER OB GYN PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3217 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785023217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9568004378 | ||||||||
| FaxNumber: | 9568004379 | ||||||||
| Practice Location | |||||||||
| Address1: | 4422 S MCCOLL RD | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785399608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9568004378 | ||||||||
| FaxNumber: | 9568004379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2014 | ||||||||
| LastUpdateDate: | 01/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | CAVAZOS | ||||||||
| AuthorizedOfficialFirstName: | SUEHAYNEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING CREDENTIALING OFIICER | ||||||||
| AuthorizedOfficialTelephone: | 9562053630 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.