Healthcare Provider Details

I. General information

NPI: 1972877918
Provider Name (Legal Business Name): ANDRES TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13225 KELOWNA ST E104
PACOIMA CA
91331-4001
US

IV. Provider business mailing address

13225 KELOWNA ST E104
PACOIMA CA
91331-4001
US

V. Phone/Fax

Practice location:
  • Phone: 818-895-5002
  • Fax: 818-895-5502
Mailing address:
  • Phone: 818-895-5002
  • Fax: 818-895-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: