Healthcare Provider Details

I. General information

NPI: 1609027424
Provider Name (Legal Business Name): REBEKAH GRACE TORRES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBEKAH GRACE LONG

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JOURNEY SUITE 210
ALISO VIEJO CA
92656-5336
US

IV. Provider business mailing address

5 JOURNEY STE 210
ALISO VIEJO CA
92656-5332
US

V. Phone/Fax

Practice location:
  • Phone: 949-305-7122
  • Fax:
Mailing address:
  • Phone: 949-305-7122
  • Fax: 949-305-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number601628
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: