Provider Demographics
NPI:1902017601
Name:JORGE TORRES
Entity Type:Organization
Organization Name:JORGE TORRES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-842-3073
Mailing Address - Street 1:8169 CALLE CONCORDIA
Mailing Address - Street 2:CONDOMINIO SAN VICENTE SUITE 1
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1555
Mailing Address - Country:US
Mailing Address - Phone:787-842-3073
Mailing Address - Fax:787-844-8510
Practice Address - Street 1:CALLE MUNOZ RIVERA #60
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-845-7700
Practice Address - Fax:787-845-6218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9822261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085020BMedicare ID - Type Unspecified