1225601081 NPI number — SURELYS DE LA TORRE ESTEVEZ CBHCM

Table of content: SURELYS DE LA TORRE ESTEVEZ CBHCM (NPI 1225601081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225601081 NPI number — SURELYS DE LA TORRE ESTEVEZ CBHCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LA TORRE ESTEVEZ
Provider First Name:
SURELYS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CBHCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225601081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15924 SW 92ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMETTO BAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33157-1842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-964-5824
Provider Business Mailing Address Fax Number:
786-452-1200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10520 NW 26TH ST STE 201&C202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33172-5940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-364-5182
Provider Business Practice Location Address Fax Number:
305-456-6243
Provider Enumeration Date:
07/20/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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