Provider Demographics
NPI:1609063692
Name:DELATORRE, CHRISTINE DIANE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DIANE
Last Name:DELATORRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 BRUNSWICK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5166
Mailing Address - Country:US
Mailing Address - Phone:530-271-1770
Mailing Address - Fax:
Practice Address - Street 1:375 BRUNSWICK RD STE 103
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5166
Practice Address - Country:US
Practice Address - Phone:530-271-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter