Healthcare Provider Details

I. General information

NPI: 1316811672
Provider Name (Legal Business Name): NICOLAS JOHN TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 CAMINO DEL SOL # 1
OXNARD CA
93030-3725
US

IV. Provider business mailing address

1500 CAMINO DEL SOL # 1
OXNARD CA
93030-3725
US

V. Phone/Fax

Practice location:
  • Phone: 805-322-5412
  • Fax:
Mailing address:
  • Phone: 805-322-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-KIGSYQ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: