Healthcare Provider Details

I. General information

NPI: 1518242635
Provider Name (Legal Business Name): ALYSSA NEEL TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17999 W SURPRISE FARMS LOOP S
SURPRISE AZ
85388-6641
US

IV. Provider business mailing address

17999 W SURPRISE FARMS LOOP S
SURPRISE AZ
85388-6641
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7000
  • Fax: 623-876-7361
Mailing address:
  • Phone: 623-876-7000
  • Fax: 623-876-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA7225
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: