Healthcare Provider Details

I. General information

NPI: 1932190675
Provider Name (Legal Business Name): MAXSIMO C TORRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 BECKNER RD
SANTA FE NM
87507-3691
US

IV. Provider business mailing address

4730 BECKNER RD
SANTA FE NM
87507-3691
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-4500
  • Fax: 505-443-8313
Mailing address:
  • Phone: 505-989-4500
  • Fax: 505-443-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number91-322
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: