MEDICARE: JUAN CARLOS 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

General Provider Information

NPI Number	:	1881072353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS TORRES

Provider Business Mailing Address
First Line	:	8107 SYLMAR AVE
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-5238
Country	:	US
Telephone Number	:	818-324-6283
Fax Number	:

Provider Business Practice Location Address
First Line	:	8107 SYLMAR AVE
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-5238
Country	:	US
Telephone Number	:	818-324-6283
Fax Number	:

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

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	05/15/2015

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Directions to “ JUAN CARLOS TORRES ” Practice Location

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