Provider Demographics
NPI:1164406815
Name:CANDELARIO-TORRES, EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:CANDELARIO-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:PO BOX 140279
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0279
Mailing Address - Country:US
Mailing Address - Phone:787-880-2076
Mailing Address - Fax:787-817-8894
Practice Address - Street 1:MEDICAL & PROFESSIONAL OFFICE PLAZA
Practice Address - Street 2:SUITE 132
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-0000
Practice Address - Country:US
Practice Address - Phone:787-880-2076
Practice Address - Fax:787-817-8894
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7101174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77694Medicare UPIN
PR29475CAMedicare ID - Type Unspecified