Healthcare Provider Details

I. General information

NPI: 1154314482
Provider Name (Legal Business Name): WANDA TORRES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2044 TRINITY OAKS BLVD STE 125
TRINITY FL
34655-4405
US

IV. Provider business mailing address

2044 TRINITY OAKS BLVD STE 125
TRINITY FL
34655-4405
US

V. Phone/Fax

Practice location:
  • Phone: 727-376-0060
  • Fax: 866-551-6104
Mailing address:
  • Phone: 727-376-0060
  • Fax: 866-551-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME75408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: