Healthcare Provider Details

I. General information

NPI: 1780632505
Provider Name (Legal Business Name): IVAN EUGENIO DEL TORO MARTINEZ M.D., F.A.C.O.G.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE LUIS MUNOZ MARIN, ESQ DEGETAU H.I.M.A.-SAN PABLO
CAGUAS PR
00726-4980
US

IV. Provider business mailing address

C9 CALLE 1 ALTOS DE LA FUENTE
CAGUAS PR
00727-7313
US

V. Phone/Fax

Practice location:
  • Phone: 787-653-3434
  • Fax:
Mailing address:
  • Phone: 787-258-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number5879
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: