Provider Demographics
NPI:1467191874
Name:DE LA TORRE GONZALEZ, ANGEL JOSUE (MS)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:JOSUE
Last Name:DE LA TORRE GONZALEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AVE ESMERALDA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4430
Mailing Address - Country:US
Mailing Address - Phone:787-210-1681
Mailing Address - Fax:
Practice Address - Street 1:5 AVE ESMERALDA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4430
Practice Address - Country:US
Practice Address - Phone:787-210-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling