Provider Demographics
NPI:1487629473
Name:TORRES, JUAN GERARDO (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:GERARDO
Last Name:TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N VENTURA RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3836
Mailing Address - Country:US
Mailing Address - Phone:805-983-8810
Mailing Address - Fax:805-983-8821
Practice Address - Street 1:1300 N VENTURA RD
Practice Address - Street 2:SUITE 6
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3836
Practice Address - Country:US
Practice Address - Phone:805-983-8810
Practice Address - Fax:805-983-8821
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50648207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A506480Medicaid
CA00A506480Medicaid
CAW18101Medicare ID - Type Unspecified