Healthcare Provider Details

I. General information

NPI: 1316337256
Provider Name (Legal Business Name): CENTRO UROLOGICO DR TIMOTEO TORRES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONSOLIDATED MEDICAL PLAZA SUITE 208
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 9689
CAGUAS PR
00726-9689
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-8682
  • Fax: 787-743-5474
Mailing address:
  • Phone: 787-743-8682
  • Fax: 787-743-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROLA E. TORRES
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-743-8682