Healthcare Provider Details

I. General information

NPI: 1326482811
Provider Name (Legal Business Name): EDGAR ALFONSO TORRES VILLAMIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDGAR A. TORRES MD

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N PALM AVENUE SUITE 211
PEMBROKE PINES FL
33026-3204
US

IV. Provider business mailing address

1065 NE 125TH ST STE 409
NORTH MIAMI FL
33161-5834
US

V. Phone/Fax

Practice location:
  • Phone: 954-447-0010
  • Fax: 954-447-0899
Mailing address:
  • Phone: 888-852-6672
  • Fax: 305-891-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101267833
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME134007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: