Provider Demographics
NPI:1740824085
Name:ALATORRE, BERTHA ALICIA (LPT)
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:ALICIA
Last Name:ALATORRE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:MS
Other - First Name:BERTHA
Other - Middle Name:ALICIA
Other - Last Name:ALATORRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPT
Mailing Address - Street 1:5870 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2037
Mailing Address - Country:US
Mailing Address - Phone:951-683-6596
Mailing Address - Fax:
Practice Address - Street 1:43250 MIDNIGHT CT
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-9565
Practice Address - Country:US
Practice Address - Phone:951-683-6596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26282167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician