Healthcare Provider Details

I. General information

NPI: 1396312518
Provider Name (Legal Business Name): ROELESE MIRRIAM PAYOT TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 CUTTING BLVD
RICHMOND CA
94804-2554
US

IV. Provider business mailing address

1313 CUTTING BLVD
RICHMOND CA
94804-2554
US

V. Phone/Fax

Practice location:
  • Phone: 510-232-0874
  • Fax:
Mailing address:
  • Phone: 510-232-0874
  • Fax: 510-232-8652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number289833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: