Healthcare Provider Details

I. General information

NPI: 1760818546
Provider Name (Legal Business Name): MARIA CRISTINA TORRES MSTOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA CRISTINA MOORE MSTOM

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 S DEARBORN ST
CHICAGO IL
60605-1838
US

IV. Provider business mailing address

175 N HARBOR DR APT 1501
CHICAGO IL
60601-7856
US

V. Phone/Fax

Practice location:
  • Phone: 312-588-1104
  • Fax:
Mailing address:
  • Phone: 847-337-8057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198001154
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: