Provider Demographics
NPI:1376996041
Name:TORRES, MAYRA (MSED)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 TOPPING AVE
Mailing Address - Street 2:FL 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7237
Mailing Address - Country:US
Mailing Address - Phone:646-875-2300
Mailing Address - Fax:
Practice Address - Street 1:1754 TOPPING AVE
Practice Address - Street 2:FL 1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7237
Practice Address - Country:US
Practice Address - Phone:646-875-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1319136174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist