Provider Demographics
NPI:1083199194
Name:TORRES, FEDERICO AUGUSTO (NP)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:AUGUSTO
Last Name:TORRES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-3632
Mailing Address - Country:US
Mailing Address - Phone:323-541-1411
Mailing Address - Fax:877-720-7181
Practice Address - Street 1:1331 W CENTRAL AVE APT 37
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5774
Practice Address - Country:US
Practice Address - Phone:714-914-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95010056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily