Healthcare Provider Details

I. General information

NPI: 1952507048
Provider Name (Legal Business Name): TESSIE M TORRES L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 PINE RIDGE RD STE 21
NAPLES FL
34109-2111
US

IV. Provider business mailing address

1185 WILDWOOD LAKES BLVD APT 202
NAPLES FL
34104-5813
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-0967
  • Fax: 239-566-2957
Mailing address:
  • Phone: 239-961-4082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberMA 49743
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: