Provider Demographics
NPI:1063723740
Name:FLORES TORRES, MIRIAM (PSYD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:FLORES TORRES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CALLE CULTO
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-2051
Mailing Address - Country:US
Mailing Address - Phone:787-202-2007
Mailing Address - Fax:
Practice Address - Street 1:33 CALLE CULTO
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2051
Practice Address - Country:US
Practice Address - Phone:787-202-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3755103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical