Healthcare Provider Details

I. General information

NPI: 1801750559
Provider Name (Legal Business Name): JOSE LUIS TORRES JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 JACKSON AVE
OGDEN UT
84401-0611
US

IV. Provider business mailing address

1954 JACKSON AVE
OGDEN UT
84401-0611
US

V. Phone/Fax

Practice location:
  • Phone: 801-941-3739
  • Fax:
Mailing address:
  • Phone: 801-941-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number14245284-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: