Healthcare Provider Details

I. General information

NPI: 1992238125
Provider Name (Legal Business Name): EDGAR FERNANDO DEL TORO DIEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CALLE DE DIEGO E STE 205
MAYAGUEZ PR
00680-5080
US

IV. Provider business mailing address

55 CALLE DE DIEGO E STE 205
MAYAGUEZ PR
00680-5080
US

V. Phone/Fax

Practice location:
  • Phone: 787-986-7300
  • Fax:
Mailing address:
  • Phone: 787-986-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number24225
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: