Healthcare Provider Details

I. General information

NPI: 1124875323
Provider Name (Legal Business Name): NOEMI DE LA TORRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 OVERLAND AVE
SAN DIEGO CA
92123-1260
US

IV. Provider business mailing address

700 N JOHNSON AVE STE P
EL CAJON CA
92020-2589
US

V. Phone/Fax

Practice location:
  • Phone: 858-694-3188
  • Fax:
Mailing address:
  • Phone: 619-441-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: