Healthcare Provider Details

I. General information

NPI: 1386829653
Provider Name (Legal Business Name): TORRANCE MIQUEL SPIGNER ADMINISTRATOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 BROOKCLIFF RD
CAYCE SC
29033-4202
US

IV. Provider business mailing address

402 BROOKCLIFF RD
CAYCE SC
29033-4202
US

V. Phone/Fax

Practice location:
  • Phone: 803-629-0278
  • Fax: 803-739-8795
Mailing address:
  • Phone: 803-629-0278
  • Fax: 803-739-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number000000000002053
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: