Healthcare Provider Details

I. General information

NPI: 1639482136
Provider Name (Legal Business Name): MARIA (MARA) TERESITA TORRES RN, MPH, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date: 08/18/2015
Reactivation Date: 11/08/2019

III. Provider practice location address

22750 CANYON CT
CASTRO VALLEY CA
94552-5483
US

IV. Provider business mailing address

1452 REDWOOD RD
CASTRO VALLEY CA
94552-5483
US

V. Phone/Fax

Practice location:
  • Phone: 510-305-6161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number19951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: