Provider Demographics
NPI:1770733479
Name:GONZALEZ TORRES, PEDRO LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:LUIS
Last Name:GONZALEZ TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PEDRO
Other - Middle Name:LUIS
Other - Last Name:GONZALEZ TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:63 AQUAMARINA
Mailing Address - Street 2:SENDERO DE MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-298-5618
Mailing Address - Fax:
Practice Address - Street 1:63 CALLE AQUAMARINA
Practice Address - Street 2:SENDERO DE MONTEHIEDRA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7067
Practice Address - Country:US
Practice Address - Phone:787-298-5618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR189912085R0202X
TXM8683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03504294Medicaid
NYA400078489Medicare PIN