Healthcare Provider Details

I. General information

NPI: 1043953995
Provider Name (Legal Business Name): CARLOS ANTONIO TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 NE 191ST ST STE 230
AVENTURA FL
33180-3115
US

IV. Provider business mailing address

1830 SW 87TH PL
MIAMI FL
33165-7845
US

V. Phone/Fax

Practice location:
  • Phone: 305-935-4551
  • Fax:
Mailing address:
  • Phone: 786-546-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number22942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: