Provider Demographics
NPI:1225799380
Name:LATORRE, ANGEL MANUEL JR
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:MANUEL
Last Name:LATORRE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 ALTA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-3702
Mailing Address - Country:US
Mailing Address - Phone:407-485-3697
Mailing Address - Fax:
Practice Address - Street 1:950 S MELLONVILLE AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-2237
Practice Address - Country:US
Practice Address - Phone:407-322-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9218224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant