Healthcare Provider Details

I. General information

NPI: 1457635211
Provider Name (Legal Business Name): MAIRIM G WISCOVICH-TORRES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SAN MIGUEL CALLE 6 G-1
CABO ROJO PR
00623
US

IV. Provider business mailing address

400 GRAND BLVD LOS PRADOS APT 14203
CAGUAS PR
00727-3282
US

V. Phone/Fax

Practice location:
  • Phone: 787-366-5890
  • Fax:
Mailing address:
  • Phone: 787-366-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20740
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: