Provider Demographics
NPI:1578038485
Name:DELATORRE, JOHN RUBEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RUBEN
Last Name:DELATORRE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 N 28TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8002
Mailing Address - Country:US
Mailing Address - Phone:361-960-3806
Mailing Address - Fax:
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE B120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3051
Practice Address - Country:US
Practice Address - Phone:480-777-8807
Practice Address - Fax:480-777-8871
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5029103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty