Healthcare Provider Details

I. General information

NPI: 1558284364
Provider Name (Legal Business Name): JENNIFER TORRES DIAZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 N SUNRISE AVE STE 200
ROSEVILLE CA
95661-2812
US

IV. Provider business mailing address

508 DOUGLAS ST UNIT 204
WEST SACRAMENTO CA
95605-2510
US

V. Phone/Fax

Practice location:
  • Phone: 916-839-3039
  • Fax:
Mailing address:
  • Phone: 209-605-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: