Provider Demographics
NPI:1124899968
Name:TORRES, JOSE LUIS (DO00260027)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:TORRES
Suffix:
Gender:M
Credentials:DO00260027
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:L
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO00260027
Mailing Address - Street 1:79 CALLE SOL APT 5
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-2600
Mailing Address - Country:US
Mailing Address - Phone:939-900-1125
Mailing Address - Fax:
Practice Address - Street 1:79 CALLE SOL APT 5
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-2600
Practice Address - Country:US
Practice Address - Phone:939-900-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7878103TC0700X
RE7878103TC0700X
PR007878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical