Healthcare Provider Details

I. General information

NPI: 1740794593
Provider Name (Legal Business Name): VANESSA TORRES LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10221 COMPTON AVE STE 104
WATTS CA
90002-2805
US

IV. Provider business mailing address

1425 W FOOTHILL BLVD STE 310
UPLAND CA
91786-8007
US

V. Phone/Fax

Practice location:
  • Phone: 213-385-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number101728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: