Provider Demographics
NPI:1962096644
Name:TORRES, BENJAMIN (ATC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:TORRES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S 5TH AVE APT B
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3185
Mailing Address - Country:US
Mailing Address - Phone:626-425-1168
Mailing Address - Fax:
Practice Address - Street 1:700 S 5TH AVE APT B
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3185
Practice Address - Country:US
Practice Address - Phone:626-425-1168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0707020062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer