Healthcare Provider Details

I. General information

NPI: 1891170049
Provider Name (Legal Business Name): WESLEY TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 PLYMOUTH AVE SOUTH 2
FALL RIVER MA
02721-2956
US

IV. Provider business mailing address

68 NORTH FRONT ST
NEW BEDFORD MA
02740
US

V. Phone/Fax

Practice location:
  • Phone: 508-264-7883
  • Fax:
Mailing address:
  • Phone: 508-264-7883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier043357938
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: