Provider Demographics
NPI:1003961590
Name:TORRES, MARIBEL (MT)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CALLE YAGUEZ
Mailing Address - Street 2:ESTANCIAS EL RIO
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-9620
Mailing Address - Country:US
Mailing Address - Phone:787-767-4694
Mailing Address - Fax:787-763-4347
Practice Address - Street 1:AVE.PONCE DE LEON 724
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-767-4694
Practice Address - Fax:787-763-4347
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0268291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31281Medicare ID - Type Unspecified