Provider Demographics
NPI:1700385002
Name:TORRES, REBECCA G
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:G
Last Name:TORRES
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 1:780 BRIDGEPORT AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4060
Mailing Address - Country:US
Mailing Address - Phone:216-956-9082
Mailing Address - Fax:
Practice Address - Street 1:780 BRIDGEPORT AVE APT 205
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4060
Practice Address - Country:US
Practice Address - Phone:216-956-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.162799164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse