Healthcare Provider Details

I. General information

NPI: 1144988486
Provider Name (Legal Business Name): RAELEEN SOCCORRO TORRES-GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 11/25/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 S TRINITY ST
FRESNO CA
93706-1874
US

IV. Provider business mailing address

3520 E SHIELDS AVE STE 102
FRESNO CA
93726-6923
US

V. Phone/Fax

Practice location:
  • Phone: 559-538-1230
  • Fax:
Mailing address:
  • Phone: 559-538-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: