Provider Demographics
NPI:1740382977
Name:TORRES, IDALYS ROSA
Entity Type:Individual
Prefix:MRS
First Name:IDALYS
Middle Name:ROSA
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 NW 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5537
Mailing Address - Country:US
Mailing Address - Phone:305-635-1614
Mailing Address - Fax:305-635-7476
Practice Address - Street 1:3413 NW 17TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5537
Practice Address - Country:US
Practice Address - Phone:305-635-1614
Practice Address - Fax:305-635-7476
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO3061156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician