Healthcare Provider Details

I. General information

NPI: 1033760103
Provider Name (Legal Business Name): JESUS E TORRES CANALES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1866 B ST STE 101
HAYWARD CA
94541-3184
US

IV. Provider business mailing address

425 VERNON ST
OAKLAND CA
94610-2981
US

V. Phone/Fax

Practice location:
  • Phone: 510-650-0155
  • Fax:
Mailing address:
  • Phone: 510-465-4569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1432730621
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: