Provider Demographics
NPI:1518517671
Name:TORRES ROSARIO, GABRIELA MARIA
Entity Type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:MARIA
Last Name:TORRES ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GABRIELA
Other - Middle Name:MARIA
Other - Last Name:TORRES ROSARIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDICAL AESTHETICIAN
Mailing Address - Street 1:URB. LAS FLORES CALLE#1
Mailing Address - Street 2:H31
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-512-2810
Mailing Address - Fax:
Practice Address - Street 1:CALLE HOSTOS #5B
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-512-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174V00000XOther Service ProvidersClinical Ethicist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR05Medicaid