Healthcare Provider Details

I. General information

NPI: 1720066822
Provider Name (Legal Business Name): SALVADOR TORRES-TORRES PA-C, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SE 4TH AVE STE B
FORT LAUDERDALE FL
33316-1958
US

IV. Provider business mailing address

4780 SW 64TH AVE STE 103
DAVIE FL
33314-4400
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-3804
  • Fax: 954-463-3805
Mailing address:
  • Phone: 954-434-1705
  • Fax: 800-642-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3711
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA3711
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: