Provider Demographics
NPI:1184989931
Name:DELATORRE, LOURDES (SPEECH THERAPIST)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:DELATORRE
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15432 SW 50TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4440
Mailing Address - Country:US
Mailing Address - Phone:305-469-0470
Mailing Address - Fax:
Practice Address - Street 1:8355 SW 41ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-469-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2018-05-16
Deactivation Date:2018-05-08
Deactivation Code:
Reactivation Date:2018-05-16
Provider Licenses
StateLicense IDTaxonomies
FLSZ5825235Z00000X
FLSA12297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist