Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101247647 | VA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | A102646 | CA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME114342 | FL |
N | 207YP0228X | Pediatric Otolaryngology | A102646 | CA |
NPI | 1093927329 |
---|---|
Provider Name | Jairo Ivan Torres |
First Address | Marshall, VA 20115-3755 |
Second Address | Marshall, VA 20115-3755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 19/05/2015 |