Healthcare Provider Details

I. General information

NPI: 1073089108
Provider Name (Legal Business Name): CRISTINA DIAZ CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 E SOUTHERN AVE
MESA AZ
85204-5055
US

IV. Provider business mailing address

22355 E VIA DE OLIVOS
QUEEN CREEK AZ
85142-4832
US

V. Phone/Fax

Practice location:
  • Phone: 480-782-7381
  • Fax:
Mailing address:
  • Phone: 480-469-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number218219
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number218219
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: