Provider Demographics
NPI:1073089108
Name:DIAZ, CRISTINA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22355 E VIA DE OLIVOS
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4832
Mailing Address - Country:US
Mailing Address - Phone:480-469-5775
Mailing Address - Fax:
Practice Address - Street 1:1142 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5055
Practice Address - Country:US
Practice Address - Phone:480-782-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ218219176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife