Provider Demographics
NPI:1194736827
Name:TORRES, ESTELITA GARCIA (DMD)
Entity type:Individual
Prefix:DR
First Name:ESTELITA
Middle Name:GARCIA
Last Name:TORRES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29701 S WESTERN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1359
Mailing Address - Country:US
Mailing Address - Phone:310-221-0300
Mailing Address - Fax:310-221-0580
Practice Address - Street 1:29701 S WESTERN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-1359
Practice Address - Country:US
Practice Address - Phone:310-221-0300
Practice Address - Fax:310-221-0580
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1452603OtherUNITED CONCORDIA CO. INC.
CAG92276-01Medicaid