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General NPI Number Information
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NPI Number | 1104445725
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Entity Type | Individual
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Provider Name | KATYA KERSTIN DE LA TORRE DO
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 611 DENBIGH BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-4415
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Country | US
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Telephone | 757-283-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 6222 CARVER PINE LOOP APT 6311
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-9800
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Country | US
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Telephone | 252-915-4440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102207201
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License Number State | VA
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