Provider Demographics
NPI:1699913293
Name:CDT MARIO CANALES TORRESOLA
Entity type:Organization
Organization Name:CDT MARIO CANALES TORRESOLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:ZAMORA
Authorized Official - Last Name:AMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-828-0305
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-0488
Mailing Address - Country:US
Mailing Address - Phone:787-828-0305
Mailing Address - Fax:787-828-0901
Practice Address - Street 1:2 CALLE CEMENTERIO
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-1452
Practice Address - Country:US
Practice Address - Phone:787-828-0305
Practice Address - Fax:787-828-0901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CDT MARIO CANALES TORRESOLA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty