MEDICARE: ROANNE TORRES CMT

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	225700000X	Massage Therapist	87534	CA

General Provider Information

NPI Number	:	1780350736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROANNE TORRES CMT

Provider Business Mailing Address
First Line	:	4184 IOWA ST APT 8
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-1992
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 FIFTH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5053
Country	:	US
Telephone Number	:	619-354-8252
Fax Number	:

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

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	08/19/2021

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