Healthcare Provider Details

I. General information

NPI: 1427579606
Provider Name (Legal Business Name): EDWIN JOMAR TORRES REYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 08/02/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL PAVIA ARECIBO CARRETERA 129 KM 1.0 AV SAN LUIS
ARECIBO PR
00613
US

IV. Provider business mailing address

557 OCEANIA APARTMENTS
ARECIBO PR
00612-5170
US

V. Phone/Fax

Practice location:
  • Phone: 787-650-7272
  • Fax:
Mailing address:
  • Phone: 787-306-2686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number21426
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: