Basic Information
| Provider Information | |||||||||
| NPI: | 1811342975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORRES | ||||||||
| FirstName: | YANELQUIS | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ACOSTA DUQUE | ||||||||
| OtherFirstName: | YANELQUIS | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1133 JOHN FREEMAN BLVD | ||||||||
| Address2: | JJL308S | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135007521 | ||||||||
| FaxNumber: | 7135007619 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 E 28TH ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2016 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME141456 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.