Healthcare Provider Details

I. General information

NPI: 1508485194
Provider Name (Legal Business Name): YANIEL TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 DEL PRADO BLVD S
CAPE CORAL FL
33990-2659
US

IV. Provider business mailing address

819 DEL PRADO BLVD S
CAPE CORAL FL
33990-2659
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-3700
  • Fax:
Mailing address:
  • Phone: 239-772-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN27375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: