Healthcare Provider Details

I. General information

NPI: 1528421450
Provider Name (Legal Business Name): ROSA M TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 BUENA VISTA DR
SUNLAND PARK NM
88063-9181
US

IV. Provider business mailing address

PO BOX 70
ANTHONY NM
88021-0070
US

V. Phone/Fax

Practice location:
  • Phone: 575-589-1180
  • Fax:
Mailing address:
  • Phone: 575-882-6101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberX-09443
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: