Healthcare Provider Details

I. General information

NPI: 1265692503
Provider Name (Legal Business Name): ANGEL M TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 CALLE ACUARIO VENUS GARDENS
SAN JUAN PR
00926-4901
US

IV. Provider business mailing address

PO BOX 71325 SUITE 137
SAN JUAN PR
00936-8425
US

V. Phone/Fax

Practice location:
  • Phone: 787-531-4839
  • Fax:
Mailing address:
  • Phone: 787-531-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberTCAMB231
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: