Provider Demographics
NPI:1336633460
Name:TORRES PEREZ, MIGUEL ANTONIO (PH D)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANTONIO
Last Name:TORRES PEREZ
Suffix:
Gender:M
Credentials:PH D
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 274
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-0274
Mailing Address - Country:US
Mailing Address - Phone:787-363-1180
Mailing Address - Fax:
Practice Address - Street 1:103 GUILLERMO ESTEVES
Practice Address - Street 2:SUITE B
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664
Practice Address - Country:US
Practice Address - Phone:787-363-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5884103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical