Provider Demographics
NPI:1912934357
Name:SAN CRISTOBAL DIAGNOSTIC & THERAPY GROUP
Entity Type:Organization
Organization Name:SAN CRISTOBAL DIAGNOSTIC & THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-843-2715
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1088
Mailing Address - Country:US
Mailing Address - Phone:787-843-2715
Mailing Address - Fax:787-843-2720
Practice Address - Street 1:TORRE SAN CRISTOBAL
Practice Address - Street 2:OFIC 314
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-843-2715
Practice Address - Fax:787-843-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7175207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7175OtherMEDICAL LICENSE