Provider Demographics
NPI:1306404405
Name:TORRES, SOPHIA ALEXIS
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ALEXIS
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 1:2630 W RUMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0155
Mailing Address - Country:US
Mailing Address - Phone:209-222-2378
Mailing Address - Fax:209-473-3344
Practice Address - Street 1:2630 W RUMBLE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0155
Practice Address - Country:US
Practice Address - Phone:209-222-2378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19-0840-159533106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician