Healthcare Provider Details

I. General information

NPI: 1124552062
Provider Name (Legal Business Name): ANTONIO JOSE TORRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/13/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 W 49TH PL
HIALEAH FL
33012-3113
US

IV. Provider business mailing address

1475 W 49TH PL
HIALEAH FL
33012-3113
US

V. Phone/Fax

Practice location:
  • Phone: 786-775-0372
  • Fax:
Mailing address:
  • Phone: 786-775-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number16-696
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number33192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: