Healthcare Provider Details

I. General information

NPI: 1053291450
Provider Name (Legal Business Name): MARLENE TORRES PPS-220186895
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21950 NISQUALLY RD
APPLE VALLEY CA
92308-5770
US

IV. Provider business mailing address

12555 NAVAJO RD
APPLE VALLEY CA
92308-7256
US

V. Phone/Fax

Practice location:
  • Phone: 760-240-4252
  • Fax:
Mailing address:
  • Phone: 760-247-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberPPS-220186895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: