MEDICARE: HEISY CUELLAR DE LA TORRE

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	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942717103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEISY CUELLAR DE LA TORRE

Provider Business Mailing Address
First Line	:	3780 8TH AVE NE
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-4923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6732 LONE OAK BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-6834
Country	:	US
Telephone Number	:	239-351-0675
Fax Number	:	239-631-5295

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

Provider Enumeration Date	:	01/09/2018
Last Update Date	:	05/15/2023

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