Provider Demographics
NPI:1891259784
Name:TORRES SANTIAGO, ELIEZER
Entity Type:Individual
Prefix:
First Name:ELIEZER
Middle Name:
Last Name:TORRES SANTIAGO
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:HH5 CALLE PELICANO
Mailing Address - Street 2:URB. DORADO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-342-1302
Mailing Address - Fax:787-278-8888
Practice Address - Street 1:188 CALLE NORTE
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-2743
Practice Address - Country:US
Practice Address - Phone:787-278-8888
Practice Address - Fax:787-278-8888
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6301103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6301OtherPSICOLOGIST LICENCE