Provider Demographics
NPI:1124552062
Name:TORRES, ANTONIO JOSE
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:JOSE
Last Name:TORRES
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 1:12066 SW 42ND ST APT 204
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7979
Mailing Address - Country:US
Mailing Address - Phone:786-775-0372
Mailing Address - Fax:
Practice Address - Street 1:12066 SW 42ND ST APT 204
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7979
Practice Address - Country:US
Practice Address - Phone:786-775-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16-696246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant