Provider Demographics
NPI:1710162763
Name:DIAZ, CHRISTOPHER JOHN (CHP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:DIAZ
Suffix:
Gender:M
Credentials:CHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 BRAGAW ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3401
Mailing Address - Country:US
Mailing Address - Phone:907-562-4155
Mailing Address - Fax:907-563-2891
Practice Address - Street 1:625 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHENEGA BAY
Practice Address - State:AK
Practice Address - Zip Code:99574-8029
Practice Address - Country:US
Practice Address - Phone:907-573-5129
Practice Address - Fax:907-573-5148
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020963Medicaid