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General NPI Number Information
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NPI Number | 1588479745
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Entity Type | Individual
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Provider Name | IMELDA DACLAG TORRES
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 494 BLOSSOM WAY
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City | CHERRYLAND
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State | CA
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Zip | 94541-1948
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Country | US
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Telephone | 510-582-7676
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Fax | 510-582-0467
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Provider Business Mailing Address
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Address Line | 2222 SANDPIPER CT
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City | SAN LEANDRO
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State | CA
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Zip | 94579-2753
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Country | US
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Telephone | 510-329-6162
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 641959
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License Number State | CA
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