Healthcare Provider Details

I. General information

NPI: 1003699489
Provider Name (Legal Business Name): ISABEL DE LA TORRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 THIRD STREET
LA VERNE CA
91750
US

IV. Provider business mailing address

4255 FILHURST AVE
BALDWIN PARK CA
91706-2851
US

V. Phone/Fax

Practice location:
  • Phone: 626-478-5732
  • Fax:
Mailing address:
  • Phone: 626-478-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: