Provider Demographics
NPI:1063999886
Name:TORRES, JESSICA MARIA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
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 1:8200 NW 41ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6204
Mailing Address - Country:US
Mailing Address - Phone:305-401-5259
Mailing Address - Fax:786-364-1842
Practice Address - Street 1:14936 SW 104TH ST APT 23
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5232
Practice Address - Country:US
Practice Address - Phone:305-632-7053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician