Provider Demographics
NPI:1124910062
Name:JEFFERSON, TORYONN PATRICK
Entity type:Individual
Prefix:
First Name:TORYONN
Middle Name:PATRICK
Last Name:JEFFERSON
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 1:1223 S LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-5249
Mailing Address - Country:US
Mailing Address - Phone:553-931-1001
Mailing Address - Fax:559-802-3489
Practice Address - Street 1:1223 S LOVERS LN
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-5249
Practice Address - Country:US
Practice Address - Phone:553-931-1001
Practice Address - Fax:559-802-3489
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-WBAMFP175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist