Healthcare Provider Details

I. General information

NPI: 1164510632
Provider Name (Legal Business Name): POLITA TORRES LIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BU-1 AVE LAS AMERICAS RESIDENCIAL BAIROA
CAGUAS PR
00725
US

IV. Provider business mailing address

P.O. BOX 1861
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-6434
  • Fax: 787-745-5660
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2406
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: