Provider Demographics
NPI:1205860715
Name:TORRES, MARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name: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 1500
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-1500
Mailing Address - Country:US
Mailing Address - Phone:787-894-4394
Mailing Address - Fax:
Practice Address - Street 1:CALLE A #41 BDA NUEVA
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-1500
Practice Address - Country:US
Practice Address - Phone:787-894-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9668208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-1893(TO)OtherTRIPLE S PROVIDER NUMBER
PR068512OtherCRUZ AZUL PROVIDER NUMBER
PR068512OtherCRUZ AZUL PROVIDER NUMBER