Basic Information
| Provider Information | |||||||||
| NPI: | 1093743262 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORRES | ||||||||
| FirstName: | EMILIO | ||||||||
| MiddleName: | BUENAVENTURA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1447 MEDICAL PARK BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334143164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612041449 | ||||||||
| FaxNumber: | 5612041461 | ||||||||
| Practice Location | |||||||||
| Address1: | 1447 MEDICAL PARK BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334143164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612041449 | ||||||||
| FaxNumber: | 5612041461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 05/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME83642 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 263131800 | 05 | FL | MEDICAID |