Healthcare Provider Details

I. General information

NPI: 1538598230
Provider Name (Legal Business Name): JULIO A. TORRES IZQUIERDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3189 ST. SAN FARIA BO. BEJUCO
ISABELA PR
00662
US

IV. Provider business mailing address

3189 SINFONIA ST. BO. BEJUCO
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 787-464-1447
  • Fax:
Mailing address:
  • Phone: 787-546-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05331
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JULIO A. TORRES IZQUIERDO
Title or Position: GRADUATED NURSE
Credential: NS
Phone: 787-464-1447