Provider Demographics
NPI:1881787521
Name:TORRES-RUSSOTTO, DIEGO RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:RAFAEL
Last Name:TORRES-RUSSOTTO
Suffix:
Gender:M
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:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8102
Mailing Address - Country:US
Mailing Address - Phone:786-594-6880
Mailing Address - Fax:402-559-5010
Practice Address - Street 1:8950 N KENDALL DR STE 410W
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2127
Practice Address - Country:US
Practice Address - Phone:786-596-3876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE248882084N0400X
MO20070123002084N0400X
FLME1592292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology