Provider Demographics
NPI:1184329567
Name:SAN ANTONIO MEDICAL LLC
Entity type:Organization
Organization Name:SAN ANTONIO MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-630-0173
Mailing Address - Street 1:PO BOX 1366
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1366
Mailing Address - Country:US
Mailing Address - Phone:787-630-0173
Mailing Address - Fax:939-666-0390
Practice Address - Street 1:BARRIO CACAO
Practice Address - Street 2:CARRETERA 474 KM 0.1
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-630-0173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization