Healthcare Provider Details

I. General information

NPI: 1306132444
Provider Name (Legal Business Name): MRS. LARA MOHAMAD TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 W ASHLAN AVE
FRESNO CA
93722-4307
US

IV. Provider business mailing address

PO BOX 737
SAN JOAQUIN CA
93660-0737
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-6660
  • Fax:
Mailing address:
  • Phone: 559-693-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: