Provider Demographics
NPI:1114044351
Name:DR BRENDA LATORRE PSC DENTIST
Entity Type:Organization
Organization Name:DR BRENDA LATORRE PSC DENTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LATORRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-283-1420
Mailing Address - Street 1:PO BOX 1445
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1445
Mailing Address - Country:US
Mailing Address - Phone:787-283-1420
Mailing Address - Fax:787-760-6652
Practice Address - Street 1:EXPRESO TRUJILLO ALTO INT CARR #850
Practice Address - Street 2:BO LAS CUEVAS TERCER PISO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-283-1420
Practice Address - Fax:787-760-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty