Provider Demographics
NPI:1710466487
Name:DE LA TORRE, HAYLEY VICTORIA
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:VICTORIA
Last Name:DE LA TORRE
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 1:7622 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6099
Mailing Address - Country:US
Mailing Address - Phone:951-827-3849
Mailing Address - Fax:
Practice Address - Street 1:7622 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-6099
Practice Address - Country:US
Practice Address - Phone:951-827-3849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health