Provider Demographics
NPI:1679864235
Name:TORRES, JAQUELINE (STAFF)
Entity type:Individual
Prefix:MS
First Name:JAQUELINE
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:STAFF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2457
Mailing Address - Country:US
Mailing Address - Phone:305-303-5435
Mailing Address - Fax:
Practice Address - Street 1:9555 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-2457
Practice Address - Country:US
Practice Address - Phone:305-303-5435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLT62042985647-0172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685650196Medicaid