Healthcare Provider Details

I. General information

NPI: 1659326114
Provider Name (Legal Business Name): ANIBAL TORNES ACOSTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S CUEVAS BUSTAMANTE 525 PARQUE CENTRAL
SAN JUAN PR
00918-2642
US

IV. Provider business mailing address

525 CALLE CUEVAS BUSTAMANTE
SAN JUAN PR
00918-2642
US

V. Phone/Fax

Practice location:
  • Phone: 787-614-9285
  • Fax: 787-765-7468
Mailing address:
  • Phone: 787-616-4674
  • Fax: 787-772-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15268
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: