MEDICARE: ASHLEE NICOLE TORRES LPT

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	167G00000X	Licensed Psychiatric Technician	37470	CA

General Provider Information

NPI Number	:	1801215082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEE NICOLE TORRES LPT

Provider Business Mailing Address
First Line	:	231 E BIANCHI RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-7430
Country	:	US
Telephone Number	:	209-271-6987
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 E BIANCHI RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-7430
Country	:	US
Telephone Number	:	209-271-6987
Fax Number	:

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	04/15/2014

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