Healthcare Provider Details

I. General information

NPI: 1497902365
Provider Name (Legal Business Name): RICARDO L MACHADO TORRES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CALLE MARIA MONAGAS LOCAL #1 ESQ. 65 INFANTERIA CHAMPI MEDICAL AND WELLNESS GROUP
ANASCO PR
00610
US

IV. Provider business mailing address

PO BOX 619
ANASCO PR
00610-0619
US

V. Phone/Fax

Practice location:
  • Phone: 787-229-1223
  • Fax: 787-229-1332
Mailing address:
  • Phone: 787-229-1223
  • Fax: 787-229-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17273
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: