Healthcare Provider Details

I. General information

NPI: 1255399036
Provider Name (Legal Business Name): VICTOR RAFAEL TORRES-SANTO DOMINGO SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#6 JOSE DE DIEGO STREET
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 557
CAROLINA PR
00986-0557
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-5075
  • Fax: 787-762-2461
Mailing address:
  • Phone: 787-757-5075
  • Fax: 787-762-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number5803
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: