Healthcare Provider Details

I. General information

NPI: 1912978628
Provider Name (Legal Business Name): LUIS F DELATORRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1103
US

IV. Provider business mailing address

4201 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1103
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-1471
  • Fax: 505-243-3994
Mailing address:
  • Phone: 505-247-1471
  • Fax: 505-243-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74192
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: