Healthcare Provider Details

I. General information

NPI: 1821889585
Provider Name (Legal Business Name): RANDY TORRES JR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E FLOWER ST
PHOENIX AZ
85014-5656
US

IV. Provider business mailing address

2113 S 114TH AVE
AVONDALE AZ
85323-9181
US

V. Phone/Fax

Practice location:
  • Phone: 602-954-0444
  • Fax:
Mailing address:
  • Phone: 623-433-6783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number324485
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number324485
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number324485
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: