Provider Demographics
NPI:1912462615
Name:TORRES, TAMIQUA MONIQUE (CLC)
Entity Type:Individual
Prefix:MRS
First Name:TAMIQUA
Middle Name:MONIQUE
Last Name:TORRES
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640405
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70064
Mailing Address - Country:US
Mailing Address - Phone:337-350-8319
Mailing Address - Fax:
Practice Address - Street 1:4129 IDAHO AVE #A
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065
Practice Address - Country:US
Practice Address - Phone:337-350-8319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAALPP-314016174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN