MEDICARE: DR. GUSTAVO A TORRES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ME90691	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720088784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUSTAVO A TORRES MD

Provider Business Mailing Address
First Line	:	900 W 49TH ST
Second Line	:	SUITE 450
City	:	HIALEAH
State	:	FL
Zip	:	33012-3402
Country	:	US
Telephone Number	:	305-821-4020
Fax Number	:	305-821-1125

Provider Business Practice Location Address
First Line	:	900 W 49TH ST
Second Line	:	SUITE 450
City	:	HIALEAH
State	:	FL
Zip	:	33012-3402
Country	:	US
Telephone Number	:	305-821-4020
Fax Number	:	305-821-1125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	09/30/2014

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