Healthcare Provider Details

I. General information

NPI: 1811719735
Provider Name (Legal Business Name): MARITZA RIQUENE DE LA TORRE RBT-24-388991
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8325 SUNRISE LAKES BLVD APT 201
SUNRISE FL
33322-1518
US

IV. Provider business mailing address

8325 SUNRISE LAKES BLVD APT 201
SUNRISE FL
33322-1518
US

V. Phone/Fax

Practice location:
  • Phone: 954-325-1233
  • Fax:
Mailing address:
  • Phone: 954-325-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-388991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: