Healthcare Provider Details

I. General information

NPI: 1639802242
Provider Name (Legal Business Name): ANDREW TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 S. WILMINGTON AVE. BUILDING 18 SUITE 300
LOS ANGELES CA
90059
US

IV. Provider business mailing address

12021 S. WILMINGTON AVE. BUILDING 18 SUITE 300
LOS ANGELES CA
90059
US

V. Phone/Fax

Practice location:
  • Phone: 424-454-6199
  • Fax:
Mailing address:
  • Phone: 424-454-6199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: