Healthcare Provider Details

I. General information

NPI: 1326977679
Provider Name (Legal Business Name): JEREMY JAMES TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 N STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

IV. Provider business mailing address

1308 N STOCKTON HILL RD # A108
KINGMAN AZ
86401-5139
US

V. Phone/Fax

Practice location:
  • Phone: 928-757-2101
  • Fax:
Mailing address:
  • Phone: 208-409-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number26AZ0512
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: