Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 14809 | PR |
NPI | 1043253743 |
---|---|
Provider Name | Mr. Justo Luis Torres |
First Address | Morovis, PR 00687-2900 |
Second Address | Caguas, PR 00725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 24/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7250337 | HUMANA REFORMA (01) | PR |