Healthcare Provider Details

I. General information

NPI: 1245290246
Provider Name (Legal Business Name): RAYMUNDO TORRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: REYMUNDO TORRES MD

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HWY 491 N
SHIPROCK NM
87420
US

IV. Provider business mailing address

PO BOX 160
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-6001
  • Fax: 505-368-7011
Mailing address:
  • Phone: 505-368-6001
  • Fax: 505-368-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number15641
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15641
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: