Provider Demographics
NPI:1053648592
Name:TORRES CORDERO, ILEANA A (MA)
Entity Type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:A
Last Name:TORRES CORDERO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 CALLE DR BASORA N
Mailing Address - Street 2:EDIFICIO IV OF. 201
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4810
Mailing Address - Country:US
Mailing Address - Phone:787-265-5583
Mailing Address - Fax:787-265-8145
Practice Address - Street 1:55 CALLE DR BASORA N
Practice Address - Street 2:EDIFICIO IV OF. 201
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4810
Practice Address - Country:US
Practice Address - Phone:787-265-5583
Practice Address - Fax:787-265-8145
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR002153103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist