Provider Demographics
NPI:1932342177
Name:TORRES, BERNARDINO BAUTISTA (DC)
Entity Type:Individual
Prefix:DR
First Name:BERNARDINO
Middle Name:BAUTISTA
Last Name:TORRES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BERNARD
Other - Middle Name:BAUTISTA
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:D C
Mailing Address - Street 1:7950 DUBLIN BLVD
Mailing Address - Street 2:SUITE108
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2929
Mailing Address - Country:US
Mailing Address - Phone:925-730-0220
Mailing Address - Fax:925-730-0234
Practice Address - Street 1:7950 DUBLIN BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2929
Practice Address - Country:US
Practice Address - Phone:925-730-0220
Practice Address - Fax:925-463-0646
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGM864AOtherPTAN