Provider Demographics
NPI:1629222617
Name:LATORRE-REY, PAOLA (BS)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:
Last Name:LATORRE-REY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 SHATTUCK AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2076
Mailing Address - Country:US
Mailing Address - Phone:510-704-7475
Mailing Address - Fax:510-704-7494
Practice Address - Street 1:2484 SHATTUCK AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2076
Practice Address - Country:US
Practice Address - Phone:510-704-7475
Practice Address - Fax:510-704-7494
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health