Provider Demographics
NPI:1922204866
Name:EMMA V TORRES BALTAZAR MD PLLC
Entity Type:Organization
Organization Name:EMMA V TORRES BALTAZAR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:VERGARA
Authorized Official - Last Name:TORRES BALTAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-274-4179
Mailing Address - Street 1:606 SE ROAKE AVENUE
Mailing Address - Street 2:P.O. BOX 10
Mailing Address - City:CASTLE ROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98611
Mailing Address - Country:US
Mailing Address - Phone:360-274-4179
Mailing Address - Fax:
Practice Address - Street 1:606 SE ROAKE AVENUE
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:WA
Practice Address - Zip Code:98611
Practice Address - Country:US
Practice Address - Phone:360-274-4179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8858493Medicare ID - Type Unspecified