Provider Demographics
NPI:1386744357
Name:TORPOCO, JESUS ANIBAL (MD)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:ANIBAL
Last Name:TORPOCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19231 VICTORY BLVD
Mailing Address - Street 2:SUITE 452
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6308
Mailing Address - Country:US
Mailing Address - Phone:818-881-3100
Mailing Address - Fax:818-881-3316
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:SUITE 452
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:818-881-3100
Practice Address - Fax:818-881-3316
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25606207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A256060Medicaid
CA00A256060Medicaid
CAA25606Medicare PIN