MEDICARE: ROLENDO GASTON TORRES SA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	15-563	TX

General Provider Information

NPI Number	:	1952833550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROLENDO GASTON TORRES SA-C

Provider Business Mailing Address
First Line	:	8450 CAMBRIDGE ST
Second Line	:	APT 1137
City	:	HOUSTON
State	:	TX
Zip	:	77054-3969
Country	:	US
Telephone Number	:	786-246-6386
Fax Number	:

Provider Business Practice Location Address
First Line	:	8450 CAMBRIDGE ST
Second Line	:	APT 1137
City	:	HOUSTON
State	:	TX
Zip	:	77054-3969
Country	:	US
Telephone Number	:	786-246-6386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2017
Last Update Date	:	04/01/2017

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