MEDICARE: DR. SHIRO PERERA TORQUATO PH.D.

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	103TC0700X	Clinical Psychologist	PSY14840	CA

General Provider Information

NPI Number	:	1225152705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRO PERERA TORQUATO PH.D.

Provider Business Mailing Address
First Line	:	3695 ALAMO ST STE 103
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-2188
Country	:	US
Telephone Number	:	805-527-4146
Fax Number	:	805-582-1893

Provider Business Practice Location Address
First Line	:	3695 ALAMO ST STE 103
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-2188
Country	:	US
Telephone Number	:	805-527-4146
Fax Number	:	805-582-1893

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/20/2021

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