Provider Demographics
NPI:1386865376
Name:MORENO TORRES, EDWIN
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:MORENO TORRES
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:PO BOX 3000
Mailing Address - Street 2:SUITE 257
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:787-436-3906
Mailing Address - Fax:787-842-9828
Practice Address - Street 1:FLORENCE SANTIAGO NO 47
Practice Address - Street 2:SUITE 2
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-842-9828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5645208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0027013Medicare ID - Type Unspecified
E43290Medicare UPIN