Healthcare Provider Details

I. General information

NPI: 1588479745
Provider Name (Legal Business Name): IMELDA DACLAG TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 BLOSSOM WAY
CHERRYLAND CA
94541-1948
US

IV. Provider business mailing address

2222 SANDPIPER CT
SAN LEANDRO CA
94579-2753
US

V. Phone/Fax

Practice location:
  • Phone: 510-582-7676
  • Fax: 510-582-0467
Mailing address:
  • Phone: 510-329-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number641959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: