Provider Demographics
NPI:1316565856
Name:TORRES, DINA TAMARA
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:TAMARA
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 1:338 W MAGNOLIA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-2181
Mailing Address - Country:US
Mailing Address - Phone:310-625-9447
Mailing Address - Fax:
Practice Address - Street 1:5535 BALBOA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1553
Practice Address - Country:US
Practice Address - Phone:818-728-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272239956103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)