Provider Demographics
NPI:1699860460
Name:GOMEZ-TORRES, EDWARD A (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:GOMEZ-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 1775
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1775
Mailing Address - Country:US
Mailing Address - Phone:787-397-2290
Mailing Address - Fax:
Practice Address - Street 1:CARR 14 INTERIOR KM 0.3
Practice Address - Street 2:CENTRO MEDICO MENONITA EDIFICIO PROFESIONAL SUITE 311
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-9938
Practice Address - Fax:787-738-9939
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13452207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH31041Medicare UPIN
PRHP961ZMedicare PIN