Provider Demographics
NPI:1275975096
Name:DIAZ, CHRISTINA (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 VILLAGE DR APT A
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-8305
Mailing Address - Country:US
Mailing Address - Phone:631-946-0646
Mailing Address - Fax:
Practice Address - Street 1:1107 VILLAGE DR APT A
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-8305
Practice Address - Country:US
Practice Address - Phone:631-946-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303860-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse