Healthcare Provider Details

I. General information

NPI: 1306116835
Provider Name (Legal Business Name): RAFAEL OMAR TORRES-GARCIA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANATI MEDICAL PLZ URB. ATENAS HERNANDEZ CARRION ST.
MANATI PR
00674-5507
US

IV. Provider business mailing address

URB. ALTURAS DE AGUADA STREET #4 E-16
AGUADA PR
00602
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9270870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: