Provider Demographics
NPI:1043538150
Name:TORRES, EDGAR LIBARDO (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:LIBARDO
Last Name:TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:47647 CALEO BAY DR STE 230
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8859
Mailing Address - Country:US
Mailing Address - Phone:760-474-8155
Mailing Address - Fax:442-372-7472
Practice Address - Street 1:47647 CALEO BAY DR STE 230
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-8859
Practice Address - Country:US
Practice Address - Phone:760-474-8155
Practice Address - Fax:442-372-7472
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA244039208000000X
IL036-133245208000000X
ILC173179208000000X
CAC173179208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001709901Medicare PIN