Healthcare Provider Details

I. General information

NPI: 1093524654
Provider Name (Legal Business Name): JOSE GABRIEL TORRES ALICEA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 510 KM 6.5 BO. AMUELAS, SECTOR GUANABANO
JUANA DIAZ PR
00795
US

IV. Provider business mailing address

ALTS DE COAMO 202 CALLE CUARZO
COAMO PR
00769
US

V. Phone/Fax

Practice location:
  • Phone: 787-651-6920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8557
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: