Provider Demographics
NPI:1972299030
Name:TORRES COSTA LINO, TATIANA (MD)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:TORRES COSTA LINO
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 1:521 JACK STEPHENS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5524
Mailing Address - Country:US
Mailing Address - Phone:501-686-6560
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 530
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7199
Practice Address - Country:US
Practice Address - Phone:501-686-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program