Provider Demographics
NPI:1710427570
Name:TORRES MOLINA, ARIEL LAZARO (SA-C)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:LAZARO
Last Name:TORRES MOLINA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 AQUA LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-1802
Mailing Address - Country:US
Mailing Address - Phone:239-938-4782
Mailing Address - Fax:
Practice Address - Street 1:991 AQUA LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-1802
Practice Address - Country:US
Practice Address - Phone:239-938-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14-530246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant