Provider Demographics
NPI:1396577110
Name:TORRES, JUAN DIEGO (PPS, MS)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:DIEGO
Last Name:TORRES
Suffix:
Gender:M
Credentials:PPS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25590 PROSPECT AVE APT 32E
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3151
Mailing Address - Country:US
Mailing Address - Phone:909-991-6262
Mailing Address - Fax:
Practice Address - Street 1:890 S OLIVE ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5214
Practice Address - Country:US
Practice Address - Phone:909-991-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool