Healthcare Provider Details

I. General information

NPI: 1437013679
Provider Name (Legal Business Name): SUSANA DE LA TORRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 QUINTARA ST
SAN FRANCISCO CA
94116-1273
US

IV. Provider business mailing address

1515 QUINTARA ST
SAN FRANCISCO CA
94116-1273
US

V. Phone/Fax

Practice location:
  • Phone: 415-242-2615
  • Fax:
Mailing address:
  • Phone: 415-242-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: