Provider Demographics
NPI:1093699522
Name:DIAZ-DOOLIN, DESENCE A
Entity type:Individual
Prefix:
First Name:DESENCE
Middle Name:A
Last Name:DIAZ-DOOLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 HAWES AVE APT 576
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-3845
Mailing Address - Country:US
Mailing Address - Phone:214-399-5315
Mailing Address - Fax:
Practice Address - Street 1:2275 HAWES AVE APT 576
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-3845
Practice Address - Country:US
Practice Address - Phone:214-399-5315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208280367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife