Healthcare Provider Details

I. General information

NPI: 1225536220
Provider Name (Legal Business Name): JESSICA LIANA DEVON TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 W MAHALO PL UNIT B
COMPTON CA
90220-5443
US

IV. Provider business mailing address

1180 W MAHALO PL UNIT B
COMPTON CA
90220-5443
US

V. Phone/Fax

Practice location:
  • Phone: 310-868-5331
  • Fax:
Mailing address:
  • Phone: 310-868-5379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW113703
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW113703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: