Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G43597 | CA |
Y | 207N00000X | Dermatologist | ME136979 | FL |
NPI | 1063434223 |
---|---|
Provider Name | Abel Torres |
First Address | Los Angeles, CA 90074-4701 |
Second Address | Loma Linda, CA 92354-3450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 28/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G435970 | (05) | CA |
100074300 | (05) | FL |
A49402 | (02) |