Provider Demographics
NPI:1487202925
Name:DE LA TORRE, CRISTAL
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRISTAL
Other - Middle Name:
Other - Last Name:DE LA TORRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12015 ARMSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-3102
Mailing Address - Country:US
Mailing Address - Phone:562-298-6266
Mailing Address - Fax:
Practice Address - Street 1:12015 ARMSDALE AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-3102
Practice Address - Country:US
Practice Address - Phone:562-298-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program