Healthcare Provider Details

I. General information

NPI: 1508642554
Provider Name (Legal Business Name): DR. CHRISTOPHER PABLO DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N MAIN ST STE 101
EAST LONGMEADOW MA
01028-1834
US

IV. Provider business mailing address

31 FENIMORE BLVD
SPRINGFIELD MA
01108-3518
US

V. Phone/Fax

Practice location:
  • Phone: 413-525-1870
  • Fax:
Mailing address:
  • Phone: 413-575-5923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2349893
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: