Healthcare Provider Details

I. General information

NPI: 1912910241
Provider Name (Legal Business Name): LOURDES MARIA TORRES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#11 CONCORDIA ST. SUITE 2 B
PONCE PR
00731
US

IV. Provider business mailing address

PO BOX 7371
PONCE PR
00732-7371
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-9572
  • Fax:
Mailing address:
  • Phone: 787-848-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5687
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: