Healthcare Provider Details

I. General information

NPI: 1932753209
Provider Name (Legal Business Name): LISA MARIE TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5173 SW 95TH AVE
COOPER CITY FL
33328-4123
US

IV. Provider business mailing address

5173 SW 95TH AVE
COOPER CITY FL
33328-4123
US

V. Phone/Fax

Practice location:
  • Phone: 305-343-0824
  • Fax:
Mailing address:
  • Phone: 305-343-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: