Provider Demographics
NPI:1790951085
Name:TORRES, LILLY JADETTE
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:JADETTE
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARC EL TUQUE 523 CALLE RAMOS ANTONINI STE 1
Mailing Address - Street 2:LABORATORIO CLINICO EL TUQUE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-4811
Mailing Address - Country:US
Mailing Address - Phone:787-259-1339
Mailing Address - Fax:787-259-1339
Practice Address - Street 1:PARC EL TUQUE 523 CALLE RAMOS ANTONINI STE 1
Practice Address - Street 2:LABORATORIO CLINICO EL TUQUE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-4811
Practice Address - Country:US
Practice Address - Phone:787-259-1339
Practice Address - Fax:787-259-1339
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1920246QM0706X
PR247ZC0005X
PR714291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038296Medicare PIN