Provider Demographics
NPI:1992110985
Name:TORRES COLON, MAYDA (MD)
Entity type:Individual
Prefix:
First Name:MAYDA
Middle Name:
Last Name:TORRES COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAYDA
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6100 BLUE LAGOON DR STE 365
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-7010
Mailing Address - Country:US
Mailing Address - Phone:786-322-7333
Mailing Address - Fax:
Practice Address - Street 1:3978 W HILLSBOROUGH AVE UNIT 21B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5628
Practice Address - Country:US
Practice Address - Phone:813-906-1412
Practice Address - Fax:813-413-1971
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137520208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101721400Medicaid