Provider Demographics
NPI:1629098942
Name:REILLY-TORRES, CHRISTINA M (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:M
Last Name:REILLY-TORRES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2885 TRAPPER CT
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-8013
Mailing Address - Country:US
Mailing Address - Phone:443-684-3823
Mailing Address - Fax:
Practice Address - Street 1:500 S 11TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4835
Practice Address - Country:US
Practice Address - Phone:208-232-6214
Practice Address - Fax:208-233-3416
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H93433Medicare UPIN