Provider Demographics
NPI:1518197201
Name:TORRES, ANDREA DENISE
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:DENISE
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:DENISE
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 THERESA AVE
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-9654
Mailing Address - Country:US
Mailing Address - Phone:707-561-0134
Mailing Address - Fax:707-563-8984
Practice Address - Street 1:120 THERESA AVE
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-9654
Practice Address - Country:US
Practice Address - Phone:707-561-0134
Practice Address - Fax:707-563-8984
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01AVOtherMEDICAL