Healthcare Provider Details

I. General information

NPI: 1134635022
Provider Name (Legal Business Name): ALICE Q TORREGOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 AVERY LN
BRIDGETON MO
63044-2101
US

IV. Provider business mailing address

2101 CORONA RD STE 102
COLUMBIA MO
65203-2582
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-6588
  • Fax:
Mailing address:
  • Phone: 573-234-1800
  • Fax: 573-234-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017039082
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: