Basic Information
| Provider Information | |||||||||
| NPI: | 1083126940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORSOO | ||||||||
| FirstName: | TETEVI | ||||||||
| MiddleName: | SENOUWOGBE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14573 JESUS ALMEIDA | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799381024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152356177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11050 MOUNT BELVEDERE BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT DRUM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136025438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157722778 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2017 | ||||||||
| LastUpdateDate: | 11/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.