Provider Demographics
NPI:1437250883
Name:TORRES, CARLOS MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 PATHFINDER WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3243
Mailing Address - Country:US
Mailing Address - Phone:321-639-8090
Mailing Address - Fax:321-639-8896
Practice Address - Street 1:1007 PATHFINDER WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3243
Practice Address - Country:US
Practice Address - Phone:321-639-8090
Practice Address - Fax:321-639-8896
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1711962080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263129600Medicaid
FL263129600Medicaid