Provider Demographics
NPI:1932269768
Name:TORAYA, AUGUSTO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:ANTONIO
Last Name:TORAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 N 51ST AVE
Mailing Address - Street 2:SUITE #65
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1708
Mailing Address - Country:US
Mailing Address - Phone:623-846-7608
Mailing Address - Fax:623-848-9572
Practice Address - Street 1:4550 N 51ST AVE
Practice Address - Street 2:SUITE #65
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1708
Practice Address - Country:US
Practice Address - Phone:623-846-7608
Practice Address - Fax:623-848-9572
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5563208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ220450Medicaid
AZE44627Medicare UPIN