Healthcare Provider Details

I. General information

NPI: 1730259672
Provider Name (Legal Business Name): IVELISSE TORRES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 2 KM 57 CRUCE DAVILA
BARCELONETA PR
00617
US

IV. Provider business mailing address

63 CALLE COPAMARINA VILLAS DE LA PLAYA
VEGA BAJA PR
00693-6025
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-4583
  • Fax: 787-846-2334
Mailing address:
  • Phone: 787-807-0923
  • Fax: 787-846-2334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4583
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: