Healthcare Provider Details

I. General information

NPI: 1013133982
Provider Name (Legal Business Name): ALFREDO E TORRES A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 DESIARD STREET SUITE 810
MONROE LA
71201
US

IV. Provider business mailing address

141 DESIARD STREET SUITE 810
MONROE LA
71201
US

V. Phone/Fax

Practice location:
  • Phone: 318-651-8337
  • Fax:
Mailing address:
  • Phone: 318-651-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13171R
License Number StateLA

VIII. Authorized Official

Name: ALFREDO E TORRES
Title or Position: OWNER
Credential: M.D.
Phone: 318-651-8337