Provider Demographics
NPI:1235584699
Name:TORRES, JESUS SR
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:TORRES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 34083
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9428
Mailing Address - Country:US
Mailing Address - Phone:939-585-2547
Mailing Address - Fax:
Practice Address - Street 1:541 LAKE TIVOLI BLVD APT G
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3285
Practice Address - Country:US
Practice Address - Phone:407-483-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health