Healthcare Provider Details

I. General information

NPI: 1225282387
Provider Name (Legal Business Name): DIANA TORRES M.P.H., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3573 OLD ARCHIBALD RANCH RD
ONTARIO CA
91761-9161
US

IV. Provider business mailing address

3573 OLD ARCHIBALD RANCH RD
ONTARIO CA
91761-9161
US

V. Phone/Fax

Practice location:
  • Phone: 909-947-4057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number01036370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: