=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588898324
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. ELIZABETH ROSEMARY DE LA TORRE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2009
-----------------------------------------------------
Last Update Date | 01/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 E FOOTHILL BLVD
-----------------------------------------------------
City | RIALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92376-5230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-421-4660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 S EREMLAND DR STE A
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91723-3186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-966-1577
-----------------------------------------------------
Fax | 626-966-5784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 9466
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------