Healthcare Provider Details

I. General information

NPI: 1801108733
Provider Name (Legal Business Name): MRS. JUDITH WENDY TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDITH WENDY LARA LMFT

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 ROSCOE BLVD FL 4
PANORAMA CITY CA
91402-4194
US

IV. Provider business mailing address

14500 ROSCOE BLVD FL 4 UNIT 8001
PANORAMA CITY CA
91402
US

V. Phone/Fax

Practice location:
  • Phone: 661-209-3614
  • Fax:
Mailing address:
  • Phone: 661-209-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF63555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: