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General NPI Number Information
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NPI Number | 1225237753
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Entity Type | Individual
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Provider Name | TANIA I DIAZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2007
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 3230 INTERSTATE 30 STE 100
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City | MESQUITE
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State | TX
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Zip | 75150-2662
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Country | US
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Telephone | 972-682-1791
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Fax | 972-698-7631
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Provider Business Mailing Address
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Address Line | 3230 INTERSTATE 30 STE 100
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City | MESQUITE
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State | TX
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Zip | 75150-2662
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Country | US
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Telephone | 972-682-1791
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Fax | 972-698-7631
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME 98941
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M9257
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License Number State | TX
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