Provider Demographics
NPI:1225601081
Name:DE LA TORRE ESTEVEZ, SURELYS (CBHCM)
Entity Type:Individual
Prefix:
First Name:SURELYS
Middle Name:
Last Name:DE LA TORRE ESTEVEZ
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10520 NW 26TH ST STE 201&C202
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5940
Mailing Address - Country:US
Mailing Address - Phone:305-364-5182
Mailing Address - Fax:305-456-6243
Practice Address - Street 1:10520 NW 26TH ST STE 201&C202
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5940
Practice Address - Country:US
Practice Address - Phone:305-364-5182
Practice Address - Fax:305-456-6243
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator