Healthcare Provider Details

I. General information

NPI: 1093625014
Provider Name (Legal Business Name): RICHARD TORRES
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: MR. RICKY TORRES

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 DUDLEY BLVD
MCCLELLAN CA
95652-1024
US

IV. Provider business mailing address

7711 GREENBACK LN APT 201
CITRUS HEIGHTS CA
95610-5831
US

V. Phone/Fax

Practice location:
  • Phone: 209-594-4095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: