Provider Demographics
NPI:1518121706
Name:TORRES-CARRILLO, MINERVA
Entity Type:Individual
Prefix:MS
First Name:MINERVA
Middle Name:
Last Name:TORRES-CARRILLO
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 1:2291 S VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:PALERMO
Mailing Address - State:CA
Mailing Address - Zip Code:95968-9618
Mailing Address - Country:US
Mailing Address - Phone:530-300-4457
Mailing Address - Fax:
Practice Address - Street 1:88 TABLE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-3578
Practice Address - Country:US
Practice Address - Phone:530-538-2158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01AVOtherMEDICAL