Healthcare Provider Details

I. General information

NPI: 1669088530
Provider Name (Legal Business Name): JEAN ALBERTO DE LA TORRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 PARK PLACE BLVD STE 2
KISSIMMEE FL
34741-2373
US

IV. Provider business mailing address

207 PARK PLACE BLVD STE 2
KISSIMMEE FL
34741-2373
US

V. Phone/Fax

Practice location:
  • Phone: 407-385-0728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: