Provider Demographics
NPI:1275728792
Name:TORRES, IVELISSA (MT)
Entity Type:Individual
Prefix:MRS
First Name:IVELISSA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 58 BOX 14577
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9722
Mailing Address - Country:US
Mailing Address - Phone:787-868-4999
Mailing Address - Fax:787-868-4999
Practice Address - Street 1:STREET 416 KM 7.0
Practice Address - Street 2:BO. LAGUNA
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6263246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist