Provider Demographics
NPI:1114215597
Name:IGLESIAS TORRES, EMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:IGLESIAS TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G31 CALLE 5
Mailing Address - Street 2:ALTURAS DEL MADRIGAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-841-2878
Mailing Address - Fax:
Practice Address - Street 1:2864 CALLE HIBISCUS
Practice Address - Street 2:URB VILLA FLORES
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2914
Practice Address - Country:US
Practice Address - Phone:787-841-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR019430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR019430OtherPR MEDICAL LICENSE