Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 272239956 | CA |
NPI | 1316565856 |
---|---|
Provider Name | Dina Tamara Torres |
First Address | Compton, CA 90220-2181 |
Second Address | Encino, CA 91316-1553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2020 |
Last Update Date | 10/07/2020 |