Healthcare Provider Details

I. General information

NPI: 1295574887
Provider Name (Legal Business Name): LUIS ANGEL TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4028 VIRGINIA ST
LYNWOOD CA
90262-4455
US

IV. Provider business mailing address

4028 VIRGINIA ST
LYNWOOD CA
90262-4455
US

V. Phone/Fax

Practice location:
  • Phone: 323-775-7348
  • Fax:
Mailing address:
  • Phone: 323-775-7348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: