MEDICARE: JOSE EMANUEL TORRES CORDERO MS, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	L-1070	LA

General Provider Information

NPI Number	:	1922977008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE EMANUEL TORRES CORDERO MS, BCBA

Provider Business Mailing Address
First Line	:	211 LOUIE ST APT 30
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7289
Country	:	US
Telephone Number	:	337-965-3872
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 TYBEE LN
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4172
Country	:	US
Telephone Number	:	337-240-8162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	12/17/2025

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