MEDICARE: MRS. DIANA TORRES RDH

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	124Q00000X	Dental Hygienist	29008	FL

General Provider Information

NPI Number	:	1548926728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA TORRES RDH

Provider Business Mailing Address
First Line	:	PO BOX 13024
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92170-3024
Country	:	US
Telephone Number	:	224-730-1726
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS MAKIN ISLAND LHD8
Second Line	:	UNIT 100222
City	:	FPO
State	:	AP
Zip	:	96672-9667
Country	:	US
Telephone Number	:	224-730-1726
Fax Number	:

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

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/12/2021

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