Provider Demographics
NPI:1225152705
Name:TORQUATO, SHIRO PERERA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIRO
Middle Name:PERERA
Last Name:TORQUATO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 ALAMO ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2188
Mailing Address - Country:US
Mailing Address - Phone:805-527-4146
Mailing Address - Fax:805-582-1893
Practice Address - Street 1:3695 ALAMO ST STE 103
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2188
Practice Address - Country:US
Practice Address - Phone:805-527-4146
Practice Address - Fax:805-582-1893
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA148059Medicare UPIN