Healthcare Provider Details

I. General information

NPI: 1619543428
Provider Name (Legal Business Name): CONSTANCE MARY TORREZ CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7344 MAGNOLIA AVE STE 110
RIVERSIDE CA
92504-3819
US

IV. Provider business mailing address

3286 E GUASTI RD STE 100
ONTARIO CA
91761-8646
US

V. Phone/Fax

Practice location:
  • Phone: 951-404-0856
  • Fax:
Mailing address:
  • Phone: 909-476-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberR1430180521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: