Provider Demographics
NPI:1457600967
Name:TORRES, LISA LORENA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LORENA
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 1:1010 ARROYO CIR
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-4670
Mailing Address - Country:US
Mailing Address - Phone:956-463-3478
Mailing Address - Fax:956-541-2502
Practice Address - Street 1:871 OLD ALICE RD
Practice Address - Street 2:SUITE 600 C
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8268
Practice Address - Country:US
Practice Address - Phone:956-541-2102
Practice Address - Fax:956-541-2502
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340222355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207164901Medicaid
TX149984001Medicaid
TX149984001Medicaid
TX456606Medicare PIN