Healthcare Provider Details

I. General information

NPI: 1881699577
Provider Name (Legal Business Name): JOSE MANUEL DE LA TORRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 ASHLEY OAKS CIR SUITE 101
WESLEY CHAPEL FL
33544-6400
US

IV. Provider business mailing address

2014 ASHLEY OAKS CIR SUITE 101
WESLEY CHAPEL FL
33544-6400
US

V. Phone/Fax

Practice location:
  • Phone: 813-253-2273
  • Fax: 813-844-2279
Mailing address:
  • Phone: 813-253-2273
  • Fax: 813-844-2279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME89848
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME89848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: