Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 218219 | AZ |
NPI | 1073089108 |
---|---|
Provider Name | Mrs. Cristina Diaz |
First Address | Queen Creek, AZ 85142-4832 |
Second Address | Mesa, AZ 85204-5055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2018 |
Last Update Date | 16/10/2018 |