Healthcare Provider Details

I. General information

NPI: 1033820733
Provider Name (Legal Business Name): GUSTAVO IVAN TORRES PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO JUAN SANCHEZ PR #2 KM 8.5
BAYAMON PR
00960-0248
US

IV. Provider business mailing address

BO JUAN SANCHEZ PR #2 KM 8.5
BAYAMON PR
00960
US

V. Phone/Fax

Practice location:
  • Phone: 787-782-8250
  • Fax:
Mailing address:
  • Phone: 787-782-8250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number629
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: