Organization
IDN. SVC CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WANDA I TORRES-LOPEZ (PRESIDENT)
(787) 375-7474
Entity
Organization
Contact information
Practice address
CARR 2 KM 47.7, MANATI, PR 00674
(787) 375-7474
Mailing address
PO BOX 2362, MANATI, PR 00674
(787) 375-7474
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
12447
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12447
MEDICAL LICENCE
PR
Enumeration date
03/24/2016
Last updated
03/24/2016
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