Provider Demographics
NPI:1912697491
Name:PAIVA TORRES, INGRID
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:PAIVA 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 1:4341 W MCNAB RD APT 10
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-5070
Mailing Address - Country:US
Mailing Address - Phone:954-200-1829
Mailing Address - Fax:
Practice Address - Street 1:4341 W MCNAB RD APT 10
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-5070
Practice Address - Country:US
Practice Address - Phone:954-200-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-272352106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician