Provider Demographics
NPI:1902928674
Name:BASCO TORRES, LUIS ERNESTO SR
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ERNESTO
Last Name:BASCO TORRES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 5847
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794
Mailing Address - Country:US
Mailing Address - Phone:787-857-4539
Mailing Address - Fax:787-857-2876
Practice Address - Street 1:BARRIO QUEBRADA GRANDE SECTOR TRES CAMINOS
Practice Address - Street 2:CARRETERA 152 KM 1.6 INT
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:787-857-4539
Practice Address - Fax:787-857-2876
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0057535Medicare ID - Type Unspecified