Provider Demographics
NPI:1427652866
Name:TORRES, JOSE VIDAL JR
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:VIDAL
Last Name:TORRES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-1935
Mailing Address - Country:US
Mailing Address - Phone:701-520-7120
Mailing Address - Fax:
Practice Address - Street 1:1457 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1935
Practice Address - Country:US
Practice Address - Phone:701-520-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide