MEDICARE: DR. GILBERTO JUAN DE LA TORRE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	5504	NV

General Provider Information

NPI Number	:	1184650079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GILBERTO JUAN DE LA TORRE M.D.

Provider Business Mailing Address
First Line	:	2121 E FLAMINGO RD STE 206
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5124
Country	:	US
Telephone Number	:	702-324-6196
Fax Number	:	702-436-1766

Provider Business Practice Location Address
First Line	:	2121 E FLAMINGO RD STE 206
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5124
Country	:	US
Telephone Number	:	702-369-9100
Fax Number	:	702-369-0291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	03/29/2010

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