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General NPI Number Information
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NPI Number | 1811192198
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Entity Type | Individual
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Provider Name | MARA CHRISTINA TORRES P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4655 RUFFNER ST SUITE 270
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City | SAN DIEGO
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State | CA
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Zip | 92111-2275
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Country | US
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Telephone | 180-078-7678
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Fax |
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Provider Business Mailing Address
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Address Line | 703 W HAMILTON PL APT C
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City | SAN PEDRO
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State | CA
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Zip | 90731-6344
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Country | US
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Telephone | 909-890-8025
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT 5729
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License Number State | CA
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