Healthcare Provider Details

I. General information

NPI: 1730814583
Provider Name (Legal Business Name): MR. GARY TORRES HOLGUIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2022
Last Update Date: 07/17/2022
Certification Date: 07/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CONGRESS ST STE 150
SALEM MA
01970-7310
US

IV. Provider business mailing address

35 CONGRESS ST STE 150
SALEM MA
01970-7310
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-2440
  • Fax:
Mailing address:
  • Phone: 978-745-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: