Healthcare Provider Details

I. General information

NPI: 1467763540
Provider Name (Legal Business Name): VANESSA TORRES-LLENZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE BLDG 85T2ND
BETHESDA MD
20889-2905
US

IV. Provider business mailing address

8901 WISCONSIN AVE BLDG 85T
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 301-400-2110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number243982
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD042302
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number0101261234
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: