Healthcare Provider Details

I. General information

NPI: 1548037013
Provider Name (Legal Business Name): DEREK GAMALIER TORRES DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 N LOGAN ST STE 311
DENVER CO
80203-3155
US

IV. Provider business mailing address

3100 INCA ST UNIT 533
DENVER CO
80202-2894
US

V. Phone/Fax

Practice location:
  • Phone: 720-551-8382
  • Fax:
Mailing address:
  • Phone: 787-238-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: