Healthcare Provider Details

I. General information

NPI: 1861641276
Provider Name (Legal Business Name): SAIRA TORRES RDN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W 30TH ST
SAN PEDRO CA
90731
US

IV. Provider business mailing address

PO BOX 6192
SAN PEDRO CA
90734
US

V. Phone/Fax

Practice location:
  • Phone: 424-280-6110
  • Fax:
Mailing address:
  • Phone: 424-280-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number991848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: