Healthcare Provider Details

I. General information

NPI: 1770762585
Provider Name (Legal Business Name): MARLA LOREN TORRES - TORRES M.D., FACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 ASHFORD AVENUE COND. ADA LIGIA SUITE 1
SAN JUAN PR
00907-5810
US

IV. Provider business mailing address

1452 ASHFORD AVENUE COND. ADA LIGIA SUITE 1
SAN JUAN PR
00907-5810
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-9595
  • Fax: 787-724-9494
Mailing address:
  • Phone: 787-724-9595
  • Fax: 787-724-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number17945
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number17945
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME113662
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number42450
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: