Provider Demographics
NPI:1902333545
Name:DIAZ, FERNANDO CRISTOBAL (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:CRISTOBAL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5137 LOST CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-9783
Mailing Address - Country:US
Mailing Address - Phone:919-966-1996
Mailing Address - Fax:919-966-6735
Practice Address - Street 1:5137 LOST CREEK LN
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-9783
Practice Address - Country:US
Practice Address - Phone:919-966-1996
Practice Address - Fax:919-966-6735
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-14
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV2724207RH0003X
TXBP10059520390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program