Provider Demographics
NPI:1306843511
Name:TORRES RODRIGUEZ, ANTOLIANO
Entity Type:Individual
Prefix:DR
First Name:ANTOLIANO
Middle Name:
Last Name:TORRES RODRIGUEZ
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:PLAZA 12 D-4
Mailing Address - Street 2:CAMBRIDGE PARK
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-759-8171
Mailing Address - Fax:
Practice Address - Street 1:1452 CALLE AMERICO SALAS
Practice Address - Street 2:ESQ. PAVIA
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2157
Practice Address - Country:US
Practice Address - Phone:787-722-1460
Practice Address - Fax:787-726-5223
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4849208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0096034Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER