Provider Demographics
NPI:1386261931
Name:TORRES PEREZ, NICOLE (BS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TORRES PEREZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 14746
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9256
Mailing Address - Country:US
Mailing Address - Phone:787-503-5433
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION REPARTO MARQUEZ CALLE3 B1
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-940-6254
Practice Address - Fax:787-815-6700
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR72292355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6819065Medicaid