Healthcare Provider Details

I. General information

NPI: 1215161369
Provider Name (Legal Business Name): RANDALL TORRENCE RN, RVT, RDCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 22ND ST SUITE C
LUBBOCK TX
79410-1303
US

IV. Provider business mailing address

PO BOX 93855
LUBBOCK TX
79493-3855
US

V. Phone/Fax

Practice location:
  • Phone: 806-787-0942
  • Fax: 806-771-3678
Mailing address:
  • Phone: 806-787-0942
  • Fax: 806-863-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number31849
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: