Provider Demographics
NPI:1669049748
Name:TORRECILLAS, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:TORRECILLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2249
Mailing Address - Country:US
Mailing Address - Phone:323-630-3631
Mailing Address - Fax:
Practice Address - Street 1:4099 N MISSION RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-2697
Practice Address - Country:US
Practice Address - Phone:323-221-1746
Practice Address - Fax:323-221-5176
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14723-RAC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14723-RACOtherADDICTION COUNSELOR CERTIFICATION BOARD OF CALIFORNIA