Provider Demographics
NPI:1942633144
Name:TORRES, MARILET MAGSOMBOL
Entity Type:Individual
Prefix:MISS
First Name:MARILET
Middle Name:MAGSOMBOL
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARILET
Other - Middle Name:
Other - Last Name:MAGSOMBOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:17820 LAKEWOOD BLVD
Mailing Address - Street 2:SPC 23
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-8462
Mailing Address - Country:US
Mailing Address - Phone:562-673-9029
Mailing Address - Fax:
Practice Address - Street 1:17820 LAKEWOOD BLVD
Practice Address - Street 2:SPC 23
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-8462
Practice Address - Country:US
Practice Address - Phone:562-673-9029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist