Provider Demographics
NPI:1619102076
Name:TORGUSON, TONANTZIN MARTINEZ (MS)
Entity Type:Individual
Prefix:MS
First Name:TONANTZIN
Middle Name:MARTINEZ
Last Name:TORGUSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TONANTZIN
Other - Middle Name:DIONISIA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2939 E PACIFIC COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-5729
Mailing Address - Country:US
Mailing Address - Phone:310-631-0793
Mailing Address - Fax:310-631-6915
Practice Address - Street 1:2939 E PACIFIC COMMERCE DR
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-5729
Practice Address - Country:US
Practice Address - Phone:310-631-0793
Practice Address - Fax:310-631-6915
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA960001182101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)