Provider Demographics
NPI:1710449160
Name:DE LA TORRE, GABRIEL CEDRIC
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:CEDRIC
Last Name:DE LA TORRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 PABLO KISEL BLVD STE 300C
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4230
Mailing Address - Country:US
Mailing Address - Phone:956-641-4760
Mailing Address - Fax:956-641-4762
Practice Address - Street 1:3000 PABLO KISEL BLVD STE 300C
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4230
Practice Address - Country:US
Practice Address - Phone:956-641-4760
Practice Address - Fax:956-641-4762
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist