Provider Demographics
NPI:1720499510
Name:TORRES, RUBY
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 MEDALLION DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1934
Mailing Address - Country:US
Mailing Address - Phone:510-487-8158
Mailing Address - Fax:510-431-3475
Practice Address - Street 1:2484 MEDALLION DR
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1934
Practice Address - Country:US
Practice Address - Phone:510-487-8227
Practice Address - Fax:510-431-3475
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA015600705171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator