Provider Demographics
NPI:1780732693
Name:TORRE, JOANNA (PA)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:TORRE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2121 COLORADO AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2012
Mailing Address - Country:US
Mailing Address - Phone:209-688-5210
Mailing Address - Fax:209-688-5217
Practice Address - Street 1:2121 COLORADO AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2012
Practice Address - Country:US
Practice Address - Phone:209-688-5210
Practice Address - Fax:209-688-5217
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17999363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant