MEDICARE: MR. MARC ANTHONY TORRES

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1790555696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARC ANTHONY TORRES

Provider Business Mailing Address
First Line	:	6801 W OCOTILLO RD STE B5
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-3107
Country	:	US
Telephone Number	:	267-432-7138
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 W OCOTILLO RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-3107
Country	:	US
Telephone Number	:	267-432-7138
Fax Number	:

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

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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