Provider Demographics
NPI:1386522290
Name:MINATRA, TORIN
Entity type:Individual
Prefix:
First Name:TORIN
Middle Name:
Last Name:MINATRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17374 N 89TH AVE APT 1502
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8140
Mailing Address - Country:US
Mailing Address - Phone:623-204-6719
Mailing Address - Fax:
Practice Address - Street 1:17374 N 89TH AVE APT 1502
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8140
Practice Address - Country:US
Practice Address - Phone:623-204-6719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician