Healthcare Provider Details

I. General information

NPI: 1477091809
Provider Name (Legal Business Name): ANTHONY TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 ORANGE ST # 4H
REDLANDS CA
92374-3240
US

IV. Provider business mailing address

25553 HURON ST
LOMA LINDA CA
92354-3722
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-2631
  • Fax: 909-792-2413
Mailing address:
  • Phone: 909-796-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number366426093
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number8617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: