Provider Demographics
NPI:1265034631
Name:DIAZ, LEANNA KRISTIAN (BSN RN)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:KRISTIAN
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E YANDELL DR STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5677
Mailing Address - Country:US
Mailing Address - Phone:915-747-3510
Mailing Address - Fax:
Practice Address - Street 1:1601 E YANDELL DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5677
Practice Address - Country:US
Practice Address - Phone:915-747-3510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX946745163WP0808X, 163W00000X
TX323284164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No164X00000XNursing Service ProvidersLicensed Vocational Nurse