Provider Demographics
NPI:1609404193
Name:TORRES DE JESUS, SERGIO ARMANDO (RDN)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:ARMANDO
Last Name:TORRES DE JESUS
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 SWALLOW BND
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2739
Mailing Address - Country:US
Mailing Address - Phone:787-543-5649
Mailing Address - Fax:
Practice Address - Street 1:3104 SWALLOW BND
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2739
Practice Address - Country:US
Practice Address - Phone:787-543-5649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86116235133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered