Healthcare Provider Details

I. General information

NPI: 1265034631
Provider Name (Legal Business Name): LEANNA KRISTIAN DIAZ BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E YANDELL DR STE B
EL PASO TX
79902-5677
US

IV. Provider business mailing address

1601 E YANDELL DR STE B
EL PASO TX
79902-5677
US

V. Phone/Fax

Practice location:
  • Phone: 915-747-3510
  • Fax:
Mailing address:
  • Phone: 915-747-3510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number946745
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number323284
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number946745
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: