Provider Demographics
NPI:1598243362
Name:TORRES OLMOS, MARIA ASIDALIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ASIDALIA
Last Name:TORRES OLMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASI
Other - Middle Name:
Other - Last Name:OLMOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6672
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-0672
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5410 N BRAESWOOD BLVD # 814
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-3200
Practice Address - Country:US
Practice Address - Phone:210-310-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-18-61565106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician