Provider Demographics
NPI:1871696435
Name:TORRES, RANDALL PATRICIO (PSYD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:PATRICIO
Last Name:TORRES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PATRICIO
Other - Middle Name:RANDAL
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91903-0182
Mailing Address - Country:US
Mailing Address - Phone:619-995-6239
Mailing Address - Fax:619-659-8187
Practice Address - Street 1:2153 ARNOLD WAY
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-2157
Practice Address - Country:US
Practice Address - Phone:619-995-6239
Practice Address - Fax:619-659-8187
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB32123103T00000X
CA31823103TA0400X, 103TB0200X, 103TC0700X, 103TP2701X
CAPS31823103TC0700X
CAPSY31823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy