Provider Demographics
NPI:1861480782
Name:TORRES, LORETTA M (PA)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:M
Last Name:TORRES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CALLE MEDICO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4724
Mailing Address - Country:US
Mailing Address - Phone:505-467-8372
Mailing Address - Fax:505-780-8285
Practice Address - Street 1:9 CALLE MEDICO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4724
Practice Address - Country:US
Practice Address - Phone:505-467-8372
Practice Address - Fax:505-780-8285
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000PA13363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM29726531Medicaid
NM29726531Medicaid
NM342415902Medicare ID - Type Unspecified