Provider Demographics
NPI:1326396078
Name:DIAZ-RIOS, KRISTAN TARA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTAN
Middle Name:TARA
Last Name:DIAZ-RIOS
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 1:2102 TREASURE HILLS BLVD # 3.14406
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8736
Mailing Address - Country:US
Mailing Address - Phone:956-296-1437
Mailing Address - Fax:956-296-6842
Practice Address - Street 1:1000 E DOVE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3974
Practice Address - Country:US
Practice Address - Phone:956-362-3520
Practice Address - Fax:956-362-3529
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0625207Q00000X, 207V00000X
TXR4210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81233388Medicaid
NM358318YKWYOtherMEDICARE PTAN
TX3787715-01Medicaid