Provider Demographics
NPI:1578976189
Name:DE LA TORRE, NATALIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 UNIVERSAL CITY PLZ
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91608-1002
Mailing Address - Country:US
Mailing Address - Phone:818-777-2400
Mailing Address - Fax:818-866-0324
Practice Address - Street 1:100 UNIVERSAL CITY PLZ
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91608-1002
Practice Address - Country:US
Practice Address - Phone:818-777-2400
Practice Address - Fax:818-866-0324
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant