Provider Demographics
NPI:1235595166
Name:MANNSCHRECK, DIANA BROSTEN (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:BROSTEN
Last Name:MANNSCHRECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:CAMILLE
Other - Last Name:BROSTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27131 FULSHEAR BEND DR
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1231
Mailing Address - Country:US
Mailing Address - Phone:281-612-0050
Mailing Address - Fax:281-612-0051
Practice Address - Street 1:4505 KINGWOOD DR STE 185
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-2618
Practice Address - Country:US
Practice Address - Phone:281-612-0050
Practice Address - Fax:281-612-0051
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5162207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology