Healthcare Provider Details

I. General information

NPI: 1114435351
Provider Name (Legal Business Name): CRISTINA MARIA ACOSTA DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 03/07/2023
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S TAMIAMI TRL
SARASOTA FL
34239-3509
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-4896
  • Fax: 941-917-6884
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number14655-I
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME156969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: