Healthcare Provider Details

I. General information

NPI: 1013516558
Provider Name (Legal Business Name): ANGELA MAURICIO TORRES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2020
Last Update Date: 10/24/2020
Certification Date: 10/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 CARROLL CENTRE RD STE 101
SAN DIEGO CA
92126-4581
US

IV. Provider business mailing address

9096 CAPRICORN WAY
SAN DIEGO CA
92126-4712
US

V. Phone/Fax

Practice location:
  • Phone: 858-689-4990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number732069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: