Provider Demographics
NPI:1629825203
Name:DEL TORO MARTINEZ, IVAN (PA)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:DEL TORO MARTINEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CALLE AMATISTA
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-3635
Mailing Address - Country:US
Mailing Address - Phone:787-313-2863
Mailing Address - Fax:
Practice Address - Street 1:237 AVE LOS VETERANOS
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-2509
Practice Address - Country:US
Practice Address - Phone:787-899-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1923PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant