Provider Demographics
NPI:1578755575
Name:TORRES, ITSIA VANESSA (OTL)
Entity Type:Individual
Prefix:MRS
First Name:ITSIA
Middle Name:VANESSA
Last Name:TORRES
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-0214
Mailing Address - Country:US
Mailing Address - Phone:787-315-6672
Mailing Address - Fax:
Practice Address - Street 1:BO MOROVIS SUR CARR 6622
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-0214
Practice Address - Country:US
Practice Address - Phone:787-315-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PROTL855174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist