Provider Demographics
NPI:1720105414
Name:TORRES, MILDRED (PH)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 CALLE FRANCISCO SEIN
Mailing Address - Street 2:FLORAL PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3522
Mailing Address - Country:US
Mailing Address - Phone:787-753-6951
Mailing Address - Fax:
Practice Address - Street 1:324 AVE BARBOSA
Practice Address - Street 2:HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-4315
Practice Address - Country:US
Practice Address - Phone:787-763-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist