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:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNC CHAPEL HILL PHYSICIANS OFFICE BLDG.
Mailing Address - Street 2:CB# 7305, 170 MANNING DRIVE, 3RD FLOOR
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7305
Mailing Address - Country:US
Mailing Address - Phone:919-966-1996
Mailing Address - Fax:919-966-6735
Practice Address - Street 1:UNC CHAPEL HILL PHYSICIANS OFFICE BLDG.
Practice Address - Street 2:CB# 7305, 170 MANNING DRIVE, 3RD FLOOR
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7305
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:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC262488390200000X
TXBP10059520390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program