Healthcare Provider Details

I. General information

NPI: 1164406815
Provider Name (Legal Business Name): EDWIN CANDELARIO-TORRES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL & PROFESSIONAL OFFICE PLAZA SUITE 132
HATILLO PR
00659-0000
US

IV. Provider business mailing address

PO BOX 140279
ARECIBO PR
00614-0279
US

V. Phone/Fax

Practice location:
  • Phone: 787-880-2076
  • Fax: 787-817-8894
Mailing address:
  • Phone: 787-880-2076
  • Fax: 787-817-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number7101
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number7101
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: