Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053656058 |
---|---|
Provider Name | Alfredo Torres JR. |
First Address | Las Vegas, NV 89145-3962 |
Second Address | Las Vegas, NV 89145-3962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2012 |
Last Update Date | 01/12/2012 |