Provider Demographics
NPI:1962841726
Name:TORRES, DOMINIC (QBA)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:TORRES
Suffix:
Gender:M
Credentials:QBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 BUSINESS PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-8961
Mailing Address - Country:US
Mailing Address - Phone:775-392-2611
Mailing Address - Fax:775-932-2433
Practice Address - Street 1:2560 BUSINESS PKWY STE B
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-8961
Practice Address - Country:US
Practice Address - Phone:775-392-2611
Practice Address - Fax:775-932-2433
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1265721328Medicaid