Provider Demographics
NPI:1497902365
Name:MACHADO TORRES, RICARDO L (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:L
Last Name:MACHADO 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:PO BOX 619
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0619
Mailing Address - Country:US
Mailing Address - Phone:787-229-1223
Mailing Address - Fax:787-229-1332
Practice Address - Street 1:107 CALLE MARIA MONAGAS LOCAL #1 ESQ. 65 INFANTERIA
Practice Address - Street 2:CHAMPI MEDICAL AND WELLNESS GROUP
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-229-1223
Practice Address - Fax:787-229-1332
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17273208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028648Medicare PIN