Provider Demographics
NPI:1225893688
Name:DIAZ, KRISTAL (NP)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 21ST AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07513-1373
Mailing Address - Country:US
Mailing Address - Phone:201-466-8250
Mailing Address - Fax:
Practice Address - Street 1:195 CORTLANDT ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3128
Practice Address - Country:US
Practice Address - Phone:973-759-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NK14992500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner