Provider Demographics
NPI:1225138498
Name:TORRES-CIFUENTES, GUSTAVO ADOLFO (MD)
Entity Type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:ADOLFO
Last Name:TORRES-CIFUENTES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1012 W BEVERLY BLVD # 873
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4139
Mailing Address - Country:US
Mailing Address - Phone:631-627-0809
Mailing Address - Fax:310-674-9301
Practice Address - Street 1:620 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3624
Practice Address - Country:US
Practice Address - Phone:323-869-0871
Practice Address - Fax:323-869-0875
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2024-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA70962208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H13112Medicare UPIN
1N2011Medicare ID - Type Unspecified