Provider Demographics
NPI:1245378892
Name:TORRES, PEDRO ROMAN JR
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:ROMAN
Last Name:TORRES
Suffix:JR
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 1:12162 JENTGES AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3764
Mailing Address - Country:US
Mailing Address - Phone:714-800-0531
Mailing Address - Fax:
Practice Address - Street 1:1905 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2334
Practice Address - Country:US
Practice Address - Phone:714-479-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YA0400XOtherCOUNSELOR