1063524049 NPI number — DR. RAKIYA ENGO DIALLO MD

Table of content: DR. RAKIYA ENGO DIALLO MD (NPI 1063524049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063524049 NPI number — DR. RAKIYA ENGO DIALLO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIALLO
Provider First Name:
RAKIYA
Provider Middle Name:
ENGO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AKWA
Provider Other First Name:
RAKIYA
Provider Other Middle Name:
ENGO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063524049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3334 BROADWAY BLVD
Provider Second Line Business Mailing Address:
SUITE 422
Provider Business Mailing Address City Name:
GARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75043-1585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-271-1156
Provider Business Mailing Address Fax Number:
972-271-1691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3334 BROADWAY BLVD
Provider Second Line Business Practice Location Address:
SUITE 422
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75043-1585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-271-1156
Provider Business Practice Location Address Fax Number:
972-271-1691
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  N4380 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X , with the licence number: N4380 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: N4380 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2176448 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".