Healthcare Provider Details

I. General information

NPI: 1407111636
Provider Name (Legal Business Name): KRISTINA SALINAS HOTZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-4506
  • Fax: 803-434-1537
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39882
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: