Provider Demographics
NPI:1689436578
Name:TORRES, LUCY AZUCENA (RDHAP)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:AZUCENA
Last Name:TORRES
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11373 WILD MEADOW PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-4225
Mailing Address - Country:US
Mailing Address - Phone:707-337-8895
Mailing Address - Fax:
Practice Address - Street 1:11373 WILD MEADOW PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-4225
Practice Address - Country:US
Practice Address - Phone:707-337-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP1045124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist