Basic Information
| Provider Information | |||||||||
| NPI: | 1326793233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANAHAN TORRES | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | AUXILIADORA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1511 AVE PONCE DE LEON APT 642 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009095049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876851375 | ||||||||
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| Practice Location | |||||||||
| Address1: | HOSPITAL PAVIA ARECIBO | ||||||||
| Address2: | CARRETERA 129. KM 1.0 AVE SAN LUIS | ||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876507272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2022 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 15941I | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 15941I | 01 | PR | HEALTH DEPARTMENT - GOVERNMENT OF PUERTO RICO | OTHER |