Provider Demographics
NPI:1811155534
Name:TORRES, RENE E (PA-C)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:E
Last Name:TORRES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-4051
Mailing Address - Country:US
Mailing Address - Phone:956-500-1768
Mailing Address - Fax:956-618-5140
Practice Address - Street 1:5128 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2834
Practice Address - Country:US
Practice Address - Phone:956-631-3831
Practice Address - Fax:956-618-5140
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02347363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA02347OtherSTATE LICENSE
TX333945901Medicaid
TX341322YT5EMedicare PIN