Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 154769 | MA |
Y | 2084N0402X | Child Neurologist | 154769 | MA |
NPI | 1184644536 |
---|---|
Provider Name | Alcy R Torres |
First Address | Boston, MA 02118-2371 |
Second Address | Boston, MA 02118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 04/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11001821A | (05) | MA |