Provider Demographics
NPI:1922275239
Name:EMILIO B TORRES PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:EMILIO B TORRES PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-204-1449
Mailing Address - Street 1:1397 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3186
Mailing Address - Country:US
Mailing Address - Phone:561-204-1449
Mailing Address - Fax:561-204-1461
Practice Address - Street 1:1397 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3186
Practice Address - Country:US
Practice Address - Phone:561-204-1449
Practice Address - Fax:561-204-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83642207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263131800Medicaid
FL263131800Medicaid
FL08035Medicare PIN