Provider Demographics
NPI:1073396941
Name:TORRES, SANTIAGO III
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:TORRES
Suffix:III
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 1:5312 RIO BRAVO DR STE 10
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9210
Mailing Address - Country:US
Mailing Address - Phone:575-915-1338
Mailing Address - Fax:
Practice Address - Street 1:5312 RIO BRAVO DR STE 10
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9210
Practice Address - Country:US
Practice Address - Phone:575-915-1338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker