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General NPI Number Information
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NPI Number | 1275728792
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Entity Type | Individual
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Provider Name | IVELISSA TORRES M.T.
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Gender | Female
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | STREET 416 KM 7.0 BO. LAGUNA
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-868-4999
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Fax |
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Provider Business Mailing Address
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Address Line | HC 58 BOX 14577
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City | AGUADA
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State | PR
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Zip | 00602-9722
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Country | US
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Telephone | 787-868-4999
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Fax | 787-868-4999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number | 6263
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License Number State | PR
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