Provider Demographics
NPI:1477703395
Name:DIAZ, CYNTHIA RAE (CPM, CDEM, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RAE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:CPM, CDEM, IBCLC
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:R
Other - Last Name:LYBOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM, CDEM, IBCLC
Mailing Address - Street 1:714 BAUMS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KOUTS
Mailing Address - State:IN
Mailing Address - Zip Code:46347-9617
Mailing Address - Country:US
Mailing Address - Phone:219-707-7131
Mailing Address - Fax:219-627-1869
Practice Address - Street 1:714 BAUMS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:KOUTS
Practice Address - State:IN
Practice Address - Zip Code:46347-9617
Practice Address - Country:US
Practice Address - Phone:219-707-7131
Practice Address - Fax:219-627-1869
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-28
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN90000014A176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife