Provider Demographics
NPI:1811595424
Name:TORRES, ISMENIA CELESTE
Entity Type:Individual
Prefix:
First Name:ISMENIA
Middle Name:CELESTE
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 1:5017 W 6400 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4043
Mailing Address - Country:US
Mailing Address - Phone:714-417-7057
Mailing Address - Fax:
Practice Address - Street 1:5017 W 6400 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-4043
Practice Address - Country:US
Practice Address - Phone:714-417-7057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician