Healthcare Provider Details

I. General information

NPI: 1366951857
Provider Name (Legal Business Name): TOREYUNG TAMUS COBBS CPC 1
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S. WASHINGTON ST. SUITE 202
NAPERVILLE IL
60540
US

IV. Provider business mailing address

2360 W HORIZON RIDGE PKWY STE 102
HENDERSON NV
89052-5082
US

V. Phone/Fax

Practice location:
  • Phone: 630-848-1200
  • Fax:
Mailing address:
  • Phone: 331-206-9795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.011229
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCI5134
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: