Healthcare Provider Details

I. General information

NPI: 1740554096
Provider Name (Legal Business Name): ISABEL P DE LA TORRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W HILLSIDE RD SUITE 9
LAREDO TX
78041-6903
US

IV. Provider business mailing address

220 W HILLSIDE RD SUITE 9
LAREDO TX
78041-6903
US

V. Phone/Fax

Practice location:
  • Phone: 956-724-5656
  • Fax: 956-726-3093
Mailing address:
  • Phone: 956-724-5656
  • Fax: 956-726-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License NumberCP10059
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: