MEDICARE: TRINA 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	103K00000X	Behavior Analyst	16-4585-44894	CA

General Provider Information

NPI Number	:	1760965594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINA TORRES

Provider Business Mailing Address
First Line	:	1310 TARA HILLS DR STE B
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2533
Country	:	US
Telephone Number	:	866-936-7838
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 TARA HILLS DR STE B
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2533
Country	:	US
Telephone Number	:	866-936-7838
Fax Number	:

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

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	09/07/2018

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Directions to “ TRINA TORRES ” Practice Location

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