Provider Demographics
NPI:1073328068
Name:ORTA TOGORES, EDUARDO ENRIQUE
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ENRIQUE
Last Name:ORTA TOGORES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19921 NW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6412
Mailing Address - Country:US
Mailing Address - Phone:786-515-7839
Mailing Address - Fax:
Practice Address - Street 1:19921 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6412
Practice Address - Country:US
Practice Address - Phone:786-515-7839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-409702106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician