Provider Demographics
NPI:1255638946
Name:TORRES-LOPEZ, EDITH CAROLINA (HHP, LMT)
Entity type:Individual
Prefix:MISS
First Name:EDITH CAROLINA
Middle Name:
Last Name:TORRES-LOPEZ
Suffix:
Gender:F
Credentials:HHP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 GINNYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3302
Mailing Address - Country:US
Mailing Address - Phone:209-204-7853
Mailing Address - Fax:
Practice Address - Street 1:1029 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5436
Practice Address - Country:US
Practice Address - Phone:209-204-7853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 173C00000X, 174H00000X, 226300000X
CA13880225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
No173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist