Provider Demographics
NPI:1689440844
Name:TORRALBA, MARIO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:TORRALBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N BRAZOS ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4750
Mailing Address - Country:US
Mailing Address - Phone:956-236-8877
Mailing Address - Fax:
Practice Address - Street 1:540 N BRAZOS ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4750
Practice Address - Country:US
Practice Address - Phone:956-236-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider