Provider Demographics
NPI:1033831508
Name:TORRES-NIEVES, MARIO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:TORRES-NIEVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 ALLATOONA GTWY APT 2206
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7421
Mailing Address - Country:US
Mailing Address - Phone:787-955-5777
Mailing Address - Fax:
Practice Address - Street 1:WILMA N. VAZQUEZ HOSPITAL
Practice Address - Street 2:CARR #2 KM 39.5
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124739367500000X
GARN323918367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL124739OtherCRNA LICENSE NUMBER