Provider Demographics
NPI:1598166357
Name:TORIAN, PRUDENCE
Entity Type:Individual
Prefix:
First Name:PRUDENCE
Middle Name:
Last Name:TORIAN
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 1:1078 DENNERY RD
Mailing Address - Street 2:APT 302
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-8498
Mailing Address - Country:US
Mailing Address - Phone:270-305-1652
Mailing Address - Fax:
Practice Address - Street 1:1078 DENNERY RD
Practice Address - Street 2:APT 302
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-8498
Practice Address - Country:US
Practice Address - Phone:270-305-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYT02-713-216171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator