Provider Demographics
NPI:1194023143
Name:TORRES, CHRISTINA BANUELOS
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:BANUELOS
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BRISTOL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5996
Mailing Address - Country:US
Mailing Address - Phone:714-850-8463
Mailing Address - Fax:714-850-8492
Practice Address - Street 1:2801 BRISTOL ST STE 200
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5996
Practice Address - Country:US
Practice Address - Phone:714-850-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist