Provider Demographics
NPI:1366974594
Name:TORRES-CASTILLO, MAHRY
Entity type:Individual
Prefix:
First Name:MAHRY
Middle Name:
Last Name:TORRES-CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:TORRES-DEROCHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4615 PENKWE WAY
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3719
Mailing Address - Country:US
Mailing Address - Phone:651-410-7098
Mailing Address - Fax:
Practice Address - Street 1:14955 GALAXIE AVE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4519
Practice Address - Country:US
Practice Address - Phone:952-891-7517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker