Provider Demographics
NPI:1376076075
Name:TOTORAITIS, KRISTIN ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELAINE
Last Name:TOTORAITIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 COMMERCE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0412
Mailing Address - Country:US
Mailing Address - Phone:661-327-3756
Mailing Address - Fax:
Practice Address - Street 1:5101 COMMERCE DR STE 101
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0412
Practice Address - Country:US
Practice Address - Phone:661-327-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN66194207N00000X
390200000X
CAA173599207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program