Healthcare Provider Details

I. General information

NPI: 1285159228
Provider Name (Legal Business Name): STEPHANIE TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 E LATHAM CT
GILBERT AZ
85297-3017
US

IV. Provider business mailing address

3712 E LATHAM CT
GILBERT AZ
85297-3017
US

V. Phone/Fax

Practice location:
  • Phone: 480-279-6094
  • Fax: 480-718-8788
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberSLPA10806
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: