NPIMap

Individual provider Active NPI

Rakiya Engo Diallo, MD

  • Multi-Specialty Clinic/Center
  • Garland, TX
National Provider Identifier
1063524049
Registry record updated Oct 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
N4380 Issued in TX
Practice address
3334 Broadway Blvd
Suite 422
Garland, TX 75043-1585
Phone
(972) 271-1156
Fax
(972) 271-1691
NPI assigned
Aug 31, 2006
Last updated
Oct 23, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X N4380 TX Primary
Primary Care Clinic/Center 261QP2300X N4380 TX
Urgent Care Clinic/Center 261QU0200X N4380 TX

Addresses

Primary practice location

3334 Broadway Blvd
Suite 422
Garland, TX 75043-1585

Mailing address

3334 Broadway Blvd
Suite 422
Garland, TX 75043-1585
Phone (972) 271-1156

Other identifiers 1

IdentifierTypeStateIssuer
2176448MedicaidTX

Other names 1

  • Rakiya Engo Akwa Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Castor Creek Emergency Physicians LLC Multi-Specialty Past Accepting new patients
Bonham Emergency Medicine LLC Multi-Specialty Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382486400000",
    "number": "1063524049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3334 BROADWAY BLVD",
            "address_2": "SUITE 422",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750431585",
            "telephone_number": "972-271-1156",
            "fax_number": "972-271-1691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3334 BROADWAY BLVD",
            "address_2": "SUITE 422",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750431585",
            "telephone_number": "972-271-1156",
            "fax_number": "972-271-1691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIALLO",
        "first_name": "RAKIYA",
        "middle_name": "ENGO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "TX",
            "license": "N4380",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "N4380",
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "TX",
            "license": "N4380",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2176448",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAKIYA",
            "last_name": "AKWA",
            "middle_name": "ENGO",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Garland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.