Provider Demographics
NPI:1386524932
Name:TORRES, MIRANDA NICOLE (NP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:NICOLE
Last Name:TORRES
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:10565 CIVIC CENTER DR
Mailing Address - Street 2:WEST BLDG SUITE 165
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3853
Mailing Address - Country:US
Mailing Address - Phone:909-985-2211
Mailing Address - Fax:909-985-2244
Practice Address - Street 1:10565 CIVIC CENTER DR
Practice Address - Street 2:WEST BLDG SUITE 165
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3853
Practice Address - Country:US
Practice Address - Phone:909-985-2211
Practice Address - Fax:909-985-2244
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95033643363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty