Healthcare Provider Details

I. General information

NPI: 1689319329
Provider Name (Legal Business Name): TANYA TORRES CPSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CALLE CHAMISAL
ESPANOLA NM
87532-2976
US

IV. Provider business mailing address

807 CALLE CHAMISAL
ESPANOLA NM
87532-2976
US

V. Phone/Fax

Practice location:
  • Phone: 505-372-4511
  • Fax:
Mailing address:
  • Phone: 505-372-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1335
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: