Healthcare Provider Details

I. General information

NPI: 1922937002
Provider Name (Legal Business Name): OMAR ALFONSO TORRES VILLA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 N FREEWAY BLVD STE 110
SACRAMENTO CA
95834-2926
US

IV. Provider business mailing address

12401 TIERRA ARROYO DR
EL PASO TX
79938-4794
US

V. Phone/Fax

Practice location:
  • Phone: 916-285-6691
  • Fax:
Mailing address:
  • Phone: 405-464-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: