Healthcare Provider Details

I. General information

NPI: 1083157481
Provider Name (Legal Business Name): OSCAR TORRES JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 PARK AVE STE A3
SOQUEL CA
95073-2831
US

IV. Provider business mailing address

104 WALNUT AVE SUITE 208
SANTA CRUZ CA
95060-3900
US

V. Phone/Fax

Practice location:
  • Phone: 831-423-9444
  • Fax:
Mailing address:
  • Phone: 831-423-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW26024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: