Healthcare Provider Details

I. General information

NPI: 1225915374
Provider Name (Legal Business Name): CHRISTINA MARIS COSTALES TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND ST
ORLANDO FL
32803-8208
US

IV. Provider business mailing address

3817 ALAFAYA HEIGHTS RD UNIT 133
ORLANDO FL
32828-7542
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-5500
  • Fax:
Mailing address:
  • Phone: 787-518-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4119145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: