Healthcare Provider Details

I. General information

NPI: 1104592195
Provider Name (Legal Business Name): KIARA MARIE TORRES CASTRO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 CALLE ELEONOR ROOSEVELT
SAN JUAN PR
00918-3048
US

IV. Provider business mailing address

URB LAS LOMAS 783 CALLE 33 SO
SAN JUAN PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 939-452-0718
  • Fax:
Mailing address:
  • Phone: 939-452-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2175
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: