MEDICARE: DR. MIGUEL OMAR DE LA TORRE AVITIA MD

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	208M00000X	Hospitalist Physician	190611	CA

General Provider Information

NPI Number	:	1558010363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL OMAR DE LA TORRE AVITIA MD

Provider Business Mailing Address
First Line	:	1200 N STATE ST STE A7D
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-1001
Country	:	US
Telephone Number	:	323-409-7556
Fax Number	:

Provider Business Practice Location Address
First Line	:	2051 MARENGO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1352
Country	:	US
Telephone Number	:	323-409-1000
Fax Number	:

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

Provider Enumeration Date	:	03/20/2022
Last Update Date	:	04/08/2026

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