Healthcare Provider Details

I. General information

NPI: 1760686265
Provider Name (Legal Business Name): XOLEDAD ANNAMARIA TORRES M.A. IMF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 14TH ST
OAKLAND CA
94607-2247
US

IV. Provider business mailing address

1266 14TH ST
OAKLAND CA
94607-2247
US

V. Phone/Fax

Practice location:
  • Phone: 510-473-4700
  • Fax: 510-530-8083
Mailing address:
  • Phone: 510-273-4700
  • Fax: 510-530-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number67928
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49274
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number90998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: