MEDICARE: PETER JEROME TORCIVIA

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	390200000X	Student in an Organized Health Care Education/Training Program		UT
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1034917	TX

General Provider Information

NPI Number	:	1154931723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER JEROME TORCIVIA

Provider Business Mailing Address
First Line	:	7122 STONEWALL HILL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256
Country	:	US
Telephone Number	:	210-404-9696
Fax Number	:	210-404-9466

Provider Business Practice Location Address
First Line	:	7122 STONEWALL HILL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256
Country	:	US
Telephone Number	:	210-404-9696
Fax Number	:	210-404-9466

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

Provider Enumeration Date	:	08/07/2020
Last Update Date	:	09/01/2021

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