Provider Demographics
NPI:1962744052
Name:AGUILAR TORRES, CORINA JULISSA
Entity type:Individual
Prefix:MRS
First Name:CORINA
Middle Name:JULISSA
Last Name:AGUILAR TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CORINA
Other - Middle Name:JULISSA
Other - Last Name:AGUILAR TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2209 STEINWAY ST
Mailing Address - Street 2:B-1
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1835
Mailing Address - Country:US
Mailing Address - Phone:347-681-1299
Mailing Address - Fax:
Practice Address - Street 1:2209 STEINWAY ST
Practice Address - Street 2:B-1
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1835
Practice Address - Country:US
Practice Address - Phone:347-681-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022223-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM535-210-83-065-0OtherHUSBAND DRIVER LICENSE