Healthcare Provider Details

I. General information

NPI: 1508342924
Provider Name (Legal Business Name): CONNIE CAJAVILCA-TORRES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S GLENDORA AVE
WEST COVINA CA
91790-3001
US

IV. Provider business mailing address

420 S GLENDORA AVE
WEST COVINA CA
91790-3001
US

V. Phone/Fax

Practice location:
  • Phone: 626-919-4333
  • Fax:
Mailing address:
  • Phone: 626-919-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA175335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: