Healthcare Provider Details

I. General information

NPI: 1720242712
Provider Name (Legal Business Name): VICTOR ANTONIO TORRES-COLLAZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 MARKET ST STE 1608
SAN FRANCISCO CA
94104-5317
US

IV. Provider business mailing address

582 MARKET ST STE 1608
SAN FRANCISCO CA
94104-5317
US

V. Phone/Fax

Practice location:
  • Phone: 415-521-1506
  • Fax: 877-448-3551
Mailing address:
  • Phone: 415-521-1506
  • Fax: 877-448-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberC133556
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC133556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: