Provider Demographics
NPI:1841035128
Name:DIAZ COBAS, CRISTOBAL (APRN)
Entity type:Individual
Prefix:
First Name:CRISTOBAL
Middle Name:
Last Name:DIAZ COBAS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 LANTANA RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6998
Mailing Address - Country:US
Mailing Address - Phone:305-266-2929
Mailing Address - Fax:786-558-0242
Practice Address - Street 1:4560 LANTANA RD STE 110
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6998
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:786-558-0242
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11033620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily