Provider Demographics
NPI:1720088784
Name:TORRES, GUSTAVO A (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:A
Last Name:TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:900 W 49TH ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3402
Mailing Address - Country:US
Mailing Address - Phone:305-821-4020
Mailing Address - Fax:305-821-1125
Practice Address - Street 1:900 W 49TH ST
Practice Address - Street 2:SUITE 450
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3402
Practice Address - Country:US
Practice Address - Phone:305-821-4020
Practice Address - Fax:305-821-1125
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2014-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME90691208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269665700Medicaid
FLI14145Medicare UPIN
FL269665700Medicaid