Provider Demographics
NPI:1407339153
Name:TORRES ROSADO, LAURA KRYSTAL (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KRYSTAL
Last Name:TORRES ROSADO
Suffix:
Gender:F
Credentials:MD
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 1539
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-1539
Mailing Address - Country:US
Mailing Address - Phone:787-232-6992
Mailing Address - Fax:
Practice Address - Street 1:PASEO REAL REINA ANA STREET, B13 COAMO, PR 00769
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-232-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21099208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice