Provider Demographics
NPI:1578159588
Name:TORRES, EDWIN RICARDO (BA)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:RICARDO
Last Name:TORRES
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:EDWIN
Other - Middle Name:RICARDO
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 W OLYMPIC BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3865
Mailing Address - Country:US
Mailing Address - Phone:323-999-2404
Mailing Address - Fax:
Practice Address - Street 1:1625 W OLYMPIC BLVD STE 600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3865
Practice Address - Country:US
Practice Address - Phone:323-999-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner