Healthcare Provider Details

I. General information

NPI: 1710745955
Provider Name (Legal Business Name): JOVAN TORRES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAGEBRUSH ST SW
ALBUQUERQUE NM
87105-3942
US

IV. Provider business mailing address

7605 SALTBRUSH RD SW
ALBUQUERQUE NM
87121-6345
US

V. Phone/Fax

Practice location:
  • Phone: 505-869-3200
  • Fax:
Mailing address:
  • Phone: 505-289-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number63947
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: