Healthcare Provider Details

I. General information

NPI: 1467850917
Provider Name (Legal Business Name): EDWARD SANTIAGO TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FLAMINGO APARTMENTS 10401
BAYAMON USA
00959
UM

IV. Provider business mailing address

10 FLAMINGO APARTMENTS 10401
BAYAMON USA
00959
UM

V. Phone/Fax

Practice location:
  • Phone: 787-854-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number2945
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: