Provider Demographics
NPI:1477735942
Name:SANTOS TORRES, GLADYS ENID (MD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:ENID
Last Name:SANTOS TORRES
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:COND VILLAS DEL MONTE 6050
Mailing Address - Street 2:844 BOX 44 APT. 2B8
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-385-4793
Mailing Address - Fax:
Practice Address - Street 1:COND VILLAS DEL MONTE 6050
Practice Address - Street 2:844 APT. 2B8
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-385-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16942208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRIE006AMedicaid