Provider Demographics
NPI:1184187148
Name:TORRES, BLANCA ILEANA (COTA/L)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:ILEANA
Last Name:TORRES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:ILEANA
Other - Last Name:CUELLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12289 JAMBOREE DR APT B
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-4296
Mailing Address - Country:US
Mailing Address - Phone:213-235-5659
Mailing Address - Fax:
Practice Address - Street 1:4100 LATHAM ST STE D
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1733
Practice Address - Country:US
Practice Address - Phone:951-686-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3461224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant