Healthcare Provider Details

I. General information

NPI: 1023340403
Provider Name (Legal Business Name): DIANISELLE TORRES M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 AVE ESMERALDA 141 COND. PLAZA ESMERALDA
GUAYNABO PR
00969-4280
US

IV. Provider business mailing address

469 AVE ESMERALDA 141 COND. PLAZA ESMERALDA
GUAYNABO PR
00969-4280
US

V. Phone/Fax

Practice location:
  • Phone: 787-203-8247
  • Fax: 787-998-4355
Mailing address:
  • Phone: 787-203-8247
  • Fax: 787-998-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3695
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: