Provider Demographics
NPI:1407643570
Name:TORRES MALAVE, DIEGO ALEJANDRO
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:ALEJANDRO
Last Name:TORRES MALAVE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-4708
Mailing Address - Country:US
Mailing Address - Phone:352-720-3672
Mailing Address - Fax:
Practice Address - Street 1:2255 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-4708
Practice Address - Country:US
Practice Address - Phone:352-720-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor