Healthcare Provider Details

I. General information

NPI: 1417841149
Provider Name (Legal Business Name): TYRA BRANDY TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S MOUNT VERNON AVE
COLTON CA
92324-3928
US

IV. Provider business mailing address

25424 4TH ST
SAN BERNARDINO CA
92410-5218
US

V. Phone/Fax

Practice location:
  • Phone: 909-600-0097
  • Fax:
Mailing address:
  • Phone: 585-506-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: