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General NPI Number Information
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NPI Number | 1538004288
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Entity Type | Individual
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Provider Name | KELLY DE LA TORRE
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Gender | Female
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Dates
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Enumeration Date | 04/21/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 714-390-0574
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Fax |
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Provider Business Mailing Address
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Address Line | 10933 ROCHESTER AVE
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City | LOS ANGELES
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State | CA
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Zip | 90024-7702
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Country | US
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Telephone | 714-390-0574
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 33932
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License Number State | CA
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