Healthcare Provider Details

I. General information

NPI: 1194380972
Provider Name (Legal Business Name): MAYRA TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CORPORATE CENTER DR
MONTEREY PARK CA
91754-7620
US

IV. Provider business mailing address

3729 E 1ST ST UNIT 63418
LOS ANGELES CA
90063-5023
US

V. Phone/Fax

Practice location:
  • Phone: 213-760-1047
  • Fax:
Mailing address:
  • Phone: 213-280-1832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: