Healthcare Provider Details

I. General information

NPI: 1376318022
Provider Name (Legal Business Name): KIARA LIZ TORRENS MATTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6563 STATE ROAD 54
NEW PORT RICHEY FL
34653-6003
US

IV. Provider business mailing address

8601 GUM TREE AVE
NEW PORT RICHEY FL
34653-6609
US

V. Phone/Fax

Practice location:
  • Phone: 727-380-9181
  • Fax:
Mailing address:
  • Phone: 727-452-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: