Provider Demographics
NPI:1457614216
Name:TORRES, WANDA IVETTE (MS ED)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:IVETTE
Last Name:TORRES
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 SAINT ANNS AVE
Mailing Address - Street 2:APT. #10-C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-4727
Mailing Address - Country:US
Mailing Address - Phone:347-615-9184
Mailing Address - Fax:
Practice Address - Street 1:164 SAINT ANNS AVE
Practice Address - Street 2:APT. #10-C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4727
Practice Address - Country:US
Practice Address - Phone:347-615-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY776103174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist