Provider Demographics
NPI:1144214867
Name:DIAZ, CRISTINA JOSEFA (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:JOSEFA
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 1:1177 PROVIDENCE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-278-5575
Mailing Address - Fax:781-255-0774
Practice Address - Street 1:1177 PROVIDENCE HIGHWAY
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-278-5575
Practice Address - Fax:781-255-0774
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78901207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3132064Medicaid
MANX4157Medicare PIN
MA3132064Medicaid