Healthcare Provider Details

I. General information

NPI: 1235532128
Provider Name (Legal Business Name): JOSE TORRES SR. M.R.C., T.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 03 BOX 10929
JUANA DIAZ PR
00795
US

IV. Provider business mailing address

HC 03 BOX 10929
JUANA DIAZ PR
00795
US

V. Phone/Fax

Practice location:
  • Phone: 787-901-8160
  • Fax:
Mailing address:
  • Phone: 787-901-8160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberTAC-II-05-4197
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: