Provider Demographics
NPI:1932818523
Name:TORRENCE, DEJA
Entity Type:Individual
Prefix:
First Name:DEJA
Middle Name:
Last Name:TORRENCE
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 1:2125 W GARFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60636-1014
Mailing Address - Country:US
Mailing Address - Phone:614-516-5004
Mailing Address - Fax:
Practice Address - Street 1:2125 W GARFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636-1014
Practice Address - Country:US
Practice Address - Phone:614-516-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic