Provider Demographics
NPI:1225237753
Name:DIAZ, TANIA I (MD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:I
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 INTERSTATE 30 STE 100
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2662
Mailing Address - Country:US
Mailing Address - Phone:972-682-1791
Mailing Address - Fax:972-698-7631
Practice Address - Street 1:3230 INTERSTATE 30 STE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2662
Practice Address - Country:US
Practice Address - Phone:972-682-1791
Practice Address - Fax:972-698-7631
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 98941208000000X
TXM9257208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics