Provider Demographics
NPI:1265064059
Name:TORRES GONZALEZ, LEYDIBET (CBHCMS)
Entity type:Individual
Prefix:
First Name:LEYDIBET
Middle Name:
Last Name:TORRES GONZALEZ
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15426 SW 172ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-1375
Mailing Address - Country:US
Mailing Address - Phone:786-675-0443
Mailing Address - Fax:305-847-2433
Practice Address - Street 1:15426 SW 172ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-1375
Practice Address - Country:US
Practice Address - Phone:786-675-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100910104100000X
FL9554888163W00000X
FLF09220784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No163W00000XNursing Service ProvidersRegistered Nurse