Provider Demographics
NPI:1902274400
Name:TORRES-VELAZQUEZ, BRENDA (BA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:TORRES-VELAZQUEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6786 LILAC AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-2765
Mailing Address - Country:US
Mailing Address - Phone:909-684-2952
Mailing Address - Fax:
Practice Address - Street 1:317 W F ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3205
Practice Address - Country:US
Practice Address - Phone:909-986-7111
Practice Address - Fax:909-986-0941
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1004821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program