Provider Demographics
NPI:1639482136
Name:TORRES, MARIA (MARA) TERESITA (RN, MPH, PNP)
Entity Type:Individual
Prefix:
First Name:MARIA (MARA)
Middle Name:TERESITA
Last Name:TORRES
Suffix:
Gender:F
Credentials:RN, MPH, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22750 CANYON CT
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-5483
Practice Address - Country:US
Practice Address - Phone:510-305-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2019-11-08
Deactivation Date:2015-08-18
Deactivation Code:
Reactivation Date:2019-11-08
Provider Licenses
StateLicense IDTaxonomies
CA19951363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics