Provider Demographics
NPI:1124397971
Name:TORRES, LUZ MARIELLA (RD,LD,IBCLC,RLC)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:MARIELLA
Last Name:TORRES
Suffix:
Gender:F
Credentials:RD,LD,IBCLC,RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18883 GRAND VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-4293
Mailing Address - Country:US
Mailing Address - Phone:936-647-2703
Mailing Address - Fax:
Practice Address - Street 1:18883 GRAND VIEW CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-4293
Practice Address - Country:US
Practice Address - Phone:936-647-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX862126133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered