1962610139 NPI number — GUSTAVO A TORRES MD PA

Table of content: (NPI 1962610139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962610139 NPI number — GUSTAVO A TORRES MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUSTAVO A TORRES MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962610139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 W 49TH ST
Provider Second Line Business Mailing Address:
SUITE 450
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33012-3402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-821-4020
Provider Business Mailing Address Fax Number:
305-821-1125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 W 49TH ST
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-821-4020
Provider Business Practice Location Address Fax Number:
305-821-1125
Provider Enumeration Date:
05/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
GUSTAVO
Authorized Official Middle Name:
ALBERTO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-821-4020

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME90691 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ME90691 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 269665700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017505100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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