Healthcare Provider Details

I. General information

NPI: 1003330697
Provider Name (Legal Business Name): ALEXIS TORRES RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEXIS TORRES-RODRIGUEZ MD

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

HC 3 BOX 10612
COMERIO PR
00782
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19728
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number37094
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: