Healthcare Provider Details

I. General information

NPI: 1528655396
Provider Name (Legal Business Name): GENOVEVA R TORRES RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W STASSNEY LN STE 110
AUSTIN TX
78745-3032
US

IV. Provider business mailing address

858 MIDDLE CRK
BUDA TX
78610-3056
US

V. Phone/Fax

Practice location:
  • Phone: 512-954-9321
  • Fax:
Mailing address:
  • Phone: 512-300-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number14554
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: