Healthcare Provider Details

I. General information

NPI: 1578067914
Provider Name (Legal Business Name): BLANCHE MARIE TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PP14 CALLE 5 URB CANA
BAYAMON PR
00957
US

IV. Provider business mailing address

1312 CHALETS DE BAYAMON
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-998-8866
  • Fax:
Mailing address:
  • Phone: 787-662-1749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5095
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: