Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15190 | PR |
NPI | 1003884123 |
---|---|
Provider Name | Dr. Ivan Torres Silva |
First Address | Ciales, PR 00638-1427 |
Second Address | Ciales, PR 00638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 01/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22376 | MEDICAL SERVICE (01) | PR |
I13723 | (02) | PR |