Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 49643 | FL |
Y | 208D00000X | General Practice Physician | ME49643 | FL |
NPI | 1013081397 |
---|---|
Provider Name | Pastor M Torres |
First Address | Hialeah, FL 33013-1963 |
Second Address | Hialeah, FL 33013-1963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D50529 | (02) |