Provider Demographics
NPI:1396020707
Name:DIAZ, CHRISTINA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ALEXANDRA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 NW 156TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1521
Mailing Address - Country:US
Mailing Address - Phone:305-904-9748
Mailing Address - Fax:
Practice Address - Street 1:440 SAWGRASS CORPORATE PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33325-6244
Practice Address - Country:US
Practice Address - Phone:954-745-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral