Healthcare Provider Details

I. General information

NPI: 1609825637
Provider Name (Legal Business Name): JORGE I DEL TORO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 954-384-0175
  • Fax: 954-858-0390
Mailing address:
  • Phone: 954-384-0175
  • Fax: 954-858-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME 46612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: