Healthcare Provider Details

I. General information

NPI: 1205860715
Provider Name (Legal Business Name): MARIO TORRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE A #41 BDA NUEVA
UTUADO PR
00641-1500
US

IV. Provider business mailing address

PO BOX 1500
UTUADO PR
00641-1500
US

V. Phone/Fax

Practice location:
  • Phone: 787-894-4394
  • Fax:
Mailing address:
  • Phone: 787-894-4394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9668
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: