Provider Demographics
NPI:1194364836
Name:TORRES, MARISOL (332B00000X)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:332B00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 DELTONA BLVD STE 26
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7175
Mailing Address - Country:US
Mailing Address - Phone:386-215-0425
Mailing Address - Fax:
Practice Address - Street 1:777 DELTONA BLVD STE 26
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7175
Practice Address - Country:US
Practice Address - Phone:386-215-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program