Provider Demographics
NPI:1770327660
Name:TORRES, REBECCA (CSFA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:GA
Mailing Address - Zip Code:30711-0220
Mailing Address - Country:US
Mailing Address - Phone:706-537-5624
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 220
Practice Address - Street 2:
Practice Address - City:CRANDALL
Practice Address - State:GA
Practice Address - Zip Code:30711-0220
Practice Address - Country:US
Practice Address - Phone:706-537-5624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAST61395490208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery