Provider Demographics
NPI:1942434402
Name:TORREGOSA, MARIVIC B
Entity Type:Individual
Prefix:MISS
First Name:MARIVIC
Middle Name:B
Last Name:TORREGOSA
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 1:6801 MCPHERSON RD STE 214
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6443
Mailing Address - Country:US
Mailing Address - Phone:956-795-8585
Mailing Address - Fax:956-795-8558
Practice Address - Street 1:6801 MCPHERSON RD STE 214
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6443
Practice Address - Country:US
Practice Address - Phone:956-795-8585
Practice Address - Fax:956-795-8558
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily