Provider Demographics
NPI:1619097789
Name:DE LA TORRE, ANA R (MFT)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:R
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230294
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-0294
Mailing Address - Country:US
Mailing Address - Phone:760-994-9323
Mailing Address - Fax:760-434-6673
Practice Address - Street 1:2777 JEFFERSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1743
Practice Address - Country:US
Practice Address - Phone:760-994-9323
Practice Address - Fax:760-434-6673
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41088101YM0800X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health