Healthcare Provider Details

I. General information

NPI: 1649796111
Provider Name (Legal Business Name): JESUS TORRES ZARAGOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 UNIVERSITY AVE
RIVERSIDE CA
92521-9800
US

IV. Provider business mailing address

900 UNIVERSITY AVE
RIVERSIDE CA
92521-9800
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-9197
  • Fax: 951-827-7669
Mailing address:
  • Phone: 951-827-9197
  • Fax: 951-827-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17180
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: