Provider Demographics
NPI:1821561119
Name:TORRES GONZALEZ, GIOVANNY
Entity type:Individual
Prefix:
First Name:GIOVANNY
Middle Name:
Last Name:TORRES GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:CASTANER
Mailing Address - State:PR
Mailing Address - Zip Code:00631-0094
Mailing Address - Country:US
Mailing Address - Phone:787-203-4834
Mailing Address - Fax:
Practice Address - Street 1:CARR 490 KM 0.15
Practice Address - Street 2:PLAZA HATO ARRIBA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-605-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3299225200000X
PR1199224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1199OtherOCCUPATIONAL THERAPY ASSISTANT