Provider Demographics
NPI:1679302566
Name:TORRES, JESSICA LUCERO
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LUCERO
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 1:19916 ROSCOE BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1976
Mailing Address - Country:US
Mailing Address - Phone:818-620-0331
Mailing Address - Fax:
Practice Address - Street 1:18700 OXNARD ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1413
Practice Address - Country:US
Practice Address - Phone:818-620-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker