Provider Demographics
NPI:1700869302
Name:TORRES, MARIO ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ALBERT
Last Name: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 1:2149 E WARNER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3495
Mailing Address - Country:US
Mailing Address - Phone:480-610-6100
Mailing Address - Fax:602-252-1520
Practice Address - Street 1:2090 SMOKETREE AVE N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5806
Practice Address - Country:US
Practice Address - Phone:480-610-6100
Practice Address - Fax:602-252-1520
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04730100207RN0300X
PAMD041372E207RN0300X
AZ51360207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103809Medicaid
NJ7530005Medicaid
NJ390004933Medicare PIN
F13096Medicare UPIN
NJ698490AB5Medicare PIN
AZZ185131Medicare PIN