Provider Demographics
NPI:1952833550
Name:TORRES, ROLENDO GASTON (SA-C)
Entity Type:Individual
Prefix:
First Name:ROLENDO
Middle Name:GASTON
Last Name:TORRES
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 CAMBRIDGE ST
Mailing Address - Street 2:APT 1137
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3969
Mailing Address - Country:US
Mailing Address - Phone:786-246-6386
Mailing Address - Fax:
Practice Address - Street 1:8450 CAMBRIDGE ST
Practice Address - Street 2:APT 1137
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-3969
Practice Address - Country:US
Practice Address - Phone:786-246-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15-563246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant