=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366640054
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. LUISA I TORRES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 72 CALLE POMAROSAS MONTE ELENA
-----------------------------------------------------
City | DORADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00646-5602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-459-6184
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE POMAROSA #72 MONTE ELENA
-----------------------------------------------------
City | DORADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-459-6184
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | TCAMB-437
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------