Healthcare Provider Details

I. General information

NPI: 1477919231
Provider Name (Legal Business Name): MIOZOTTY TORRES 73021
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 156.5 AVE HOSTOS OFFICE PARK 4 EDIFICIO SC. RODE SUITE 349
MAYAGUEZ PR
00680-1511
US

IV. Provider business mailing address

PO BOX 742
YAUCO PR
00698-0742
US

V. Phone/Fax

Practice location:
  • Phone: 787-710-2532
  • Fax: 787-986-7614
Mailing address:
  • Phone: 787-710-2532
  • Fax: 787-986-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number73021
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: