Healthcare Provider Details

I. General information

NPI: 1578141537
Provider Name (Legal Business Name): STEPHANIE TORRES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NEWPORT CENTER DR STE M106
NEWPORT BEACH CA
92660-7516
US

IV. Provider business mailing address

PO BOX 18025
LOS ANGELES CA
90018-0025
US

V. Phone/Fax

Practice location:
  • Phone: 949-783-9590
  • Fax:
Mailing address:
  • Phone: 424-781-7314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY35353
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: