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General NPI Number Information
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NPI Number | 1275811093
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Entity Type | Individual
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Provider Name | TERESITA AMANDA DE LA TORRE M.A., SLP
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Gender | Female
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Dates
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Enumeration Date | 07/27/2011
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 560 S CAMINO DEL PUEBLO
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City | BERNALILLO
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State | NM
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Zip | 87004-5803
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Country | US
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Telephone | 505-927-3521
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Fax | 505-867-7850
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Provider Business Mailing Address
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Address Line | 2609 CAMINO PLATA LOOP NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-5826
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Country | US
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Telephone | 505-927-3521
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP-5128
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | C-4942
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License Number State | NM
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