Provider Demographics
NPI:1609519438
Name:DAZA, JESSICA MARCELA (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARCELA
Last Name:DAZA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 WORTH PKWY APT 1110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1501
Mailing Address - Country:US
Mailing Address - Phone:346-402-5167
Mailing Address - Fax:
Practice Address - Street 1:1330 E 6TH ST STE 105
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6608
Practice Address - Country:US
Practice Address - Phone:956-289-9473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program