Provider Demographics
NPI:1669764601
Name:MARIANO TORRES M.D., INC.
Entity type:Organization
Organization Name:MARIANO TORRES M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SERVICE/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:OYAMOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-742-6841
Mailing Address - Street 1:PO BOX 1182
Mailing Address - Street 2:
Mailing Address - City:KEKAHA
Mailing Address - State:HI
Mailing Address - Zip Code:96752-1182
Mailing Address - Country:US
Mailing Address - Phone:808-639-1038
Mailing Address - Fax:
Practice Address - Street 1:4643B WAIMEA CANYON DRIVE
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796-0669
Practice Address - Country:US
Practice Address - Phone:808-639-1038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI015806Medicaid
HIH52862Medicare PIN
HIC97645Medicare UPIN