Healthcare Provider Details

I. General information

NPI: 1811529001
Provider Name (Legal Business Name): CHRISTIAN EDUARDO TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE
MODESTO CA
95350-4500
US

IV. Provider business mailing address

1524 MCHENRY AVE
MODESTO CA
95350-4500
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-5801
  • Fax:
Mailing address:
  • Phone: 209-575-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27164
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: