Provider Demographics
NPI:1942172531
Name:DIAZ, CRYSTAL MONIQUE (MSN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:MONIQUE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 VIOLET DR
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-3737
Mailing Address - Country:US
Mailing Address - Phone:909-717-8458
Mailing Address - Fax:
Practice Address - Street 1:2876 VIOLET DR
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-3737
Practice Address - Country:US
Practice Address - Phone:909-717-8458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95196694163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse