Provider Demographics
NPI:1871619346
Name:TORREBLANCA, JOSE F (DO)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:F
Last Name:TORREBLANCA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6005
Mailing Address - Country:US
Mailing Address - Phone:323-564-4408
Mailing Address - Fax:323-564-9641
Practice Address - Street 1:10001 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6005
Practice Address - Country:US
Practice Address - Phone:323-564-4408
Practice Address - Fax:323-564-9641
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10109208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871619346OtherMEDICARE
CA0AX101090Medicaid
NV100513361Medicaid
CA1871619346OtherMEDICARE