Provider Demographics
NPI:1962005637
Name:BERRIOS TORRES, OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:BERRIOS TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 AVE COMERIO MARGINAL LEVITTOWN
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-784-2218
Mailing Address - Fax:787-784-4444
Practice Address - Street 1:URB SANTA ELENA
Practice Address - Street 2:EE12 CALLE 3 A
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-1734
Practice Address - Country:US
Practice Address - Phone:939-625-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15460I208D00000X
PR23080208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty