Provider Demographics
NPI:1649777269
Name:TORRES, DAIRY (BA)
Entity Type:Individual
Prefix:
First Name:DAIRY
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 SW 163RD PSGE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4577
Mailing Address - Country:US
Mailing Address - Phone:786-757-0589
Mailing Address - Fax:
Practice Address - Street 1:4411 SW 163RD PSGE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185
Practice Address - Country:US
Practice Address - Phone:786-757-0589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018335400Medicaid