Basic Information
| Provider Information | |||||||||
| NPI: | 1265093298 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TORAL | ||||||||
| FirstName: | MARINA | ||||||||
| MiddleName: | ELENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 E MAIN ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952022908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094784554 | ||||||||
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| Practice Location | |||||||||
| Address1: | 306 E MAIN ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952022908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094784554 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2019 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2470A2800X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Health Information | Assistant Record Technician | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.