Provider Demographics
NPI:1720519689
Name:TORRES-DIAZ, KRISTINA (DO)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:TORRES-DIAZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 TIFFANY ANNE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6835
Mailing Address - Country:US
Mailing Address - Phone:954-829-5300
Mailing Address - Fax:
Practice Address - Street 1:665 DULUTH HWY
Practice Address - Street 2:SUITE 401
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3328
Practice Address - Country:US
Practice Address - Phone:678-312-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA84649207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program