Basic Information
| Provider Information | |||||||||
| NPI: | 1780632505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEL TORO MARTINEZ | ||||||||
| FirstName: | IVAN | ||||||||
| MiddleName: | EUGENIO | ||||||||
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| Credential: | M.D., F.A.C.O.G. | ||||||||
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| Mailing Information | |||||||||
| Address1: | C9 CALLE 1 | ||||||||
| Address2: | ALTOS DE LA FUENTE | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007277313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872582061 | ||||||||
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| Practice Location | |||||||||
| Address1: | AVE LUIS MUNOZ MARIN, ESQ DEGETAU | ||||||||
| Address2: | H.I.M.A.-SAN PABLO | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007264980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 12/01/2008 | ||||||||
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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 | 207VG0400X | 5879 | PR | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 98506 | 01 | PR | SSS | OTHER |