=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043737752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSE LUIS TORRES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2017
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 769 W BLAINE ST STE B
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92507-3970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-358-4705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30255 THE VINTAGE DR
-----------------------------------------------------
City | HOMELAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92548-3261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-204-7276
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | 688430
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------