Provider Demographics
NPI:1497916613
Name:TORREZ, JASNA M (MD)
Entity Type:Individual
Prefix:
First Name:JASNA
Middle Name:M
Last Name:TORREZ
Suffix:
Gender:F
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:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-0647
Mailing Address - Country:US
Mailing Address - Phone:910-483-7337
Mailing Address - Fax:910-483-0648
Practice Address - Street 1:3436 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1834
Practice Address - Country:US
Practice Address - Phone:910-426-7337
Practice Address - Fax:910-426-3097
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201600197208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2809163OtherCIGNA/GREATWEST
NC1497916613Medicaid
NC5927106OtherUNITED HEALTHCARE
NC13482688OtherPHCS/MULTIPLAN
NCFH1101960OtherFIRST CAROLINA CARE
NC261096OtherMEDCOST