Healthcare Provider Details

I. General information

NPI: 1346617487
Provider Name (Legal Business Name): CRYSTAL TORRES RDCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11328 OKEECHOBEE BLVD #9
ROYAL PALM BEACH FL
33411-8733
US

IV. Provider business mailing address

11328 OKEECHOBEE BLVD #9
ROYAL PALM BEACH FL
33411-8733
US

V. Phone/Fax

Practice location:
  • Phone: 561-779-3090
  • Fax:
Mailing address:
  • Phone: 561-779-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: