Provider Demographics
NPI:1346474830
Name:DE LA TORRE, MARIA J (MASTER OF SCIENCE IN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:J
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE IN
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 MAGNOLIA AV.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007
Mailing Address - Country:US
Mailing Address - Phone:213-342-0100
Mailing Address - Fax:213-342-0200
Practice Address - Street 1:1910 MAGNOLIA AV.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007
Practice Address - Country:US
Practice Address - Phone:213-342-0100
Practice Address - Fax:213-342-0200
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59540106H00000X, 225400000X
CAIMF59540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007782Medicaid
CAIMF59540Medicaid