Basic Information
| Provider Information | |||||||||
| NPI: | 1104345370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORRES | ||||||||
| FirstName: | RANDY | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1212 N SELFRIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | CLAWSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480171006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345607720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 29877 TELEGRAPH RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480347659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483540730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2017 | ||||||||
| LastUpdateDate: | 09/19/2017 | ||||||||
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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 | 363LF0000X | 4704261502 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.