MEDICARE: JOSE LUIS TORRES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	688430	CA

General Provider Information

NPI Number	:	1043737752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE LUIS TORRES

Provider Business Mailing Address
First Line	:	30255 THE VINTAGE DR
Second Line	:
City	:	HOMELAND
State	:	CA
Zip	:	92548-3261
Country	:	US
Telephone Number	:	951-204-7276
Fax Number	:

Provider Business Practice Location Address
First Line	:	769 W BLAINE ST STE B
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-3970
Country	:	US
Telephone Number	:	951-358-4705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	11/24/2025

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