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General NPI Number Information
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NPI Number | 1063524049
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Entity Type | Individual
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Provider Name | RAKIYA ENGO DIALLO MD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 3334 BROADWAY BLVD SUITE 422
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City | GARLAND
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State | TX
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Zip | 75043-1585
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Country | US
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Telephone | 972-271-1156
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Fax | 972-271-1691
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Provider Business Mailing Address
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Address Line | 3334 BROADWAY BLVD SUITE 422
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City | GARLAND
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State | TX
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Zip | 75043-1585
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Country | US
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Telephone | 972-271-1156
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Fax | 972-271-1691
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | N4380
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | N4380
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | N4380
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License Number State | TX
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