Healthcare Provider Details

I. General information

NPI: 1275967960
Provider Name (Legal Business Name): RAISA A. TORRES-PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 09/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029
US

IV. Provider business mailing address

1901 1ST AVE OFC 6C-4
NEW YORK NY
10029-7491
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6262
  • Fax:
Mailing address:
  • Phone: 212-423-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number31,442-R
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number292773
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: