Healthcare Provider Details

I. General information

NPI: 1255620886
Provider Name (Legal Business Name): MARTHA ROSAURA TORRES RAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 A EMILINE AVE.
SANTA CRUZ CA
95060
US

IV. Provider business mailing address

1105 E LAKE AVE APT 2
WATSONVILLE CA
95076-3491
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-0112
  • Fax:
Mailing address:
  • Phone: 831-498-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRI-T 1102241643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: