Healthcare Provider Details

I. General information

NPI: 1235122664
Provider Name (Legal Business Name): AUGUSTO TORRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 ROCKSIDE RD SUITE 2200
INDEPENDENCE OH
44131-2168
US

IV. Provider business mailing address

PO BOX 932127
CLEVELAND OH
44193-0008
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-7075
  • Fax: 216-642-7592
Mailing address:
  • Phone: 216-472-2730
  • Fax: 216-472-2740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35040408T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: