Provider Demographics
NPI:1114705761
Name:TORRES, RICARDO JOSE SR
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:JOSE
Last Name:TORRES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29736 BYRON PL
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3806
Mailing Address - Country:US
Mailing Address - Phone:323-371-3220
Mailing Address - Fax:
Practice Address - Street 1:1816 S FIGUEROA ST FL 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3422
Practice Address - Country:US
Practice Address - Phone:213-763-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC0908312172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker