Provider Demographics
NPI:1538709902
Name:TORRES-MOCTEZUMA, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:TORRES-MOCTEZUMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14428 HADDON MIST DR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-3708
Mailing Address - Country:US
Mailing Address - Phone:757-635-1104
Mailing Address - Fax:
Practice Address - Street 1:14428 HADDON MIST DR
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-3708
Practice Address - Country:US
Practice Address - Phone:757-635-1104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor