Provider Demographics
NPI:1790109106
Name:DE LA TORRE, CARLA L (MEXSC, RD, LND)
Entity Type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:L
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:MEXSC, RD, LND
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 16386
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-6386
Mailing Address - Country:US
Mailing Address - Phone:787-647-7129
Mailing Address - Fax:
Practice Address - Street 1:CALLE SANTIAGO IGLESIAS 66
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-647-7129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1410133N00000X
PR941516133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist