MEDICARE: BRANDON SAMUEL TORRES RIVERA

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208D00000X	General Practice Physician	23359	PR
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	23359	PR

General Provider Information

NPI Number	:	1942764360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON SAMUEL TORRES RIVERA

Provider Business Mailing Address
First Line	:	23 CALLE CISNE
Second Line	:	BOSQUE VERDE
City	:	CAGUAS
State	:	PR
Zip	:	00727
Country	:	US
Telephone Number	:	787-248-6773
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 CALLE CISNE
Second Line	:	BOSQUE VERDE
City	:	CAGUAS
State	:	PR
Zip	:	00727
Country	:	US
Telephone Number	:	787-248-6773
Fax Number	:

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

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	12/16/2025

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