Healthcare Provider Details

I. General information

NPI: 1851435754
Provider Name (Legal Business Name): ERNEST DE LA TORRE R.P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 465W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST STE 465W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-8591
  • Fax:
Mailing address:
  • Phone: 310-657-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: