Provider Demographics
NPI:1205053162
Name:TORRES, MARITJIM
Entity type:Individual
Prefix:
First Name:MARITJIM
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARITJIM
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:104 CALLE MIGUEL RIVERA TEXIDOR
Mailing Address - Street 2:ESTANCIAS DEL GOLF
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-0500
Mailing Address - Country:US
Mailing Address - Phone:787-608-7038
Mailing Address - Fax:
Practice Address - Street 1:104 CALLE MIGUEL RIVERA TEXIDOR
Practice Address - Street 2:ESTANCIAS DEL GOLF
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-0500
Practice Address - Country:US
Practice Address - Phone:787-608-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist