Healthcare Provider Details

I. General information

NPI: 1053317719
Provider Name (Legal Business Name): MARIO TORRES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARIO TORRES-IRIBARREN M.D.

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 36TH ST FL 2
NEW YORK NY
10018-6643
US

IV. Provider business mailing address

19021 VILLAGE BLVD
SANDY OR
97055-8104
US

V. Phone/Fax

Practice location:
  • Phone: 844-947-6782
  • Fax:
Mailing address:
  • Phone: 305-775-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number156323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: