Provider Demographics
NPI:1376189886
Name:TORRES, SUSANA MERCEDES
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:MERCEDES
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. HIGHLANDS GARDEN
Mailing Address - Street 2:AVE ESMERALDA A-1 CALLE ARPEGIO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-414-6419
Mailing Address - Fax:
Practice Address - Street 1:URB. HIGHLANDS GARDEN
Practice Address - Street 2:AVE ESMERALDA A-1 CALLE ARPEGIO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-414-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR0034991223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program