Provider Demographics
NPI:1164848248
Name:LA TORRE PEREZ, TANIA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:LA TORRE PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 FAIRWAY RD
Mailing Address - Street 2:PEMBROKE PINES
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3211
Mailing Address - Country:US
Mailing Address - Phone:754-214-5776
Mailing Address - Fax:
Practice Address - Street 1:1470 FAIRWAY RD
Practice Address - Street 2:PEMBROKE PINES
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3211
Practice Address - Country:US
Practice Address - Phone:754-214-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program