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General NPI Number Information
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NPI Number | 1528463999
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Entity Type | Organization
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Legal Business Name | IVELISSA TORRES
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | CARR 109 KM 5.4 BO ESPINO
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City | ANASCO
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State | PR
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Zip | 00610
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Country | US
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Telephone | 787-826-3006
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Fax | 787-826-3006
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | ANASCO
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State | PR
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Zip | 00610-0070
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Country | US
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Telephone | 787-826-3006
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Fax | 787-826-3006
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Authorized Official
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Title or Position | SUPERVISOR
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Name | IVELISA TORRES
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Credential | M.T.
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Telephone | 787-597-0014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 1320
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License Number State | PR
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