Provider Demographics
NPI:1770772329
Name:JOSE F TORREBLANCA DO PC
Entity type:Organization
Organization Name:JOSE F TORREBLANCA DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:F
Authorized Official - Last Name:TORREBLANCA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-734-7566
Mailing Address - Street 1:1611 E CHARLESTON BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1859
Mailing Address - Country:US
Mailing Address - Phone:702-734-7566
Mailing Address - Fax:702-880-5777
Practice Address - Street 1:1611 E CHARLESTON BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1859
Practice Address - Country:US
Practice Address - Phone:702-734-7566
Practice Address - Fax:702-880-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100513362Medicaid
NV100513362Medicaid