Provider Demographics
NPI:1740554096
Name:DE LA TORRE, ISABEL P
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:P
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 1:220 W HILLSIDE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6903
Mailing Address - Country:US
Mailing Address - Phone:956-724-5656
Mailing Address - Fax:956-726-3093
Practice Address - Street 1:220 W HILLSIDE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6903
Practice Address - Country:US
Practice Address - Phone:956-724-5656
Practice Address - Fax:956-726-3093
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCP10059156FC0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens