Provider Demographics
NPI:1043230097
Name:DE LA TORRE, LAURA E (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 N STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5727
Mailing Address - Country:US
Mailing Address - Phone:520-314-3300
Mailing Address - Fax:520-293-1957
Practice Address - Street 1:4821 N STONE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5727
Practice Address - Country:US
Practice Address - Phone:520-314-3400
Practice Address - Fax:520-293-1957
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ545866Medicaid
73451Medicare ID - Type Unspecified
AZ545866Medicaid