Provider Demographics
NPI:1851442529
Name:TORRE-IGWE, LISA M (CNS, PMHNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:TORRE-IGWE
Suffix:
Gender:F
Credentials:CNS, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 CENTRAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3148
Mailing Address - Country:US
Mailing Address - Phone:510-675-0600
Mailing Address - Fax:510-675-0185
Practice Address - Street 1:2608 CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3148
Practice Address - Country:US
Practice Address - Phone:510-675-0600
Practice Address - Fax:510-675-0185
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309627163WP0809X
CA9500581363LP0808X
CA2699364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent