=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790441590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUISITO A TORREGOSA PMHNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2021
-----------------------------------------------------
Last Update Date | 11/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 GATEWAY DR STE 13-14B
-----------------------------------------------------
City | BEL AIR
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21014-4268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-286-1258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8122 GLEN ARBOR DR
-----------------------------------------------------
City | ROSEDALE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21237-3373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-599-7935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | R168847
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------