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1275811093 NPI number — TERESITA AMANDA DE LA TORRE M.A., SLP

NPI Number: 1275811093
Health Care Provider/Practitioner: TERESITA AMANDA DE LA TORRE M.A., SLP

Information about “1275811093” NPI (TERESITA AMANDA DE LA TORRE M.A., SLP) exists in 1275811093 in HTML format HTML  |  1275811093 in plain Text format TXT  |  1275811093 in PDF (Portable Document Format) PDF  |  1275811093 in an XML format XML  formats.

NPI Number : 1275811093 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275811093",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DE LA TORRE",
    "FirstName": "TERESITA",
    "MiddleName": "AMANDA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.A., SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2609 CAMINO PLATA LOOP NE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIO RANCHO",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87144-5826",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "505-927-3521",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "560 S CAMINO DEL PUEBLO",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BERNALILLO",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87004-5803",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-927-3521",
    "PracticeLocationAddressFaxNumber": "505-867-7850",
    "EnumerationDate": "07/27/2011",
    "LastUpdateDate": "01/13/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "SLP-5128",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "C-4942",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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