Provider Demographics
NPI:1326859612
Name:DIAZ, CRISTINA FAVIOLA (FNP)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:FAVIOLA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1807
Mailing Address - Country:US
Mailing Address - Phone:575-640-6653
Mailing Address - Fax:
Practice Address - Street 1:210 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3915
Practice Address - Country:US
Practice Address - Phone:650-579-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95089824163W00000X
CA95024441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse