Provider Demographics
NPI:1295379139
Name:TORRES CHAVEZ, JORGE ENRIQUE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ENRIQUE
Last Name:TORRES CHAVEZ
Suffix:
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 1:235 N BEST AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-9410
Mailing Address - Country:US
Mailing Address - Phone:442-230-1240
Mailing Address - Fax:
Practice Address - Street 1:235 N BEST AVE APT 115
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-9410
Practice Address - Country:US
Practice Address - Phone:442-230-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA705372164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse