Provider Demographics
NPI:1902156581
Name:TORRES, MATTHEW ABRAHAM
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ABRAHAM
Last Name:TORRES
Suffix:
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 1:1416 SEVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3121
Mailing Address - Country:US
Mailing Address - Phone:209-380-7248
Mailing Address - Fax:
Practice Address - Street 1:420 E CANAL DR
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3936
Practice Address - Country:US
Practice Address - Phone:209-668-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program