Provider Demographics
NPI:1881699577
Name:DE LA TORRE, JOSE MANUEL (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:DE LA TORRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 ASHLEY OAKS CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6400
Mailing Address - Country:US
Mailing Address - Phone:813-253-2273
Mailing Address - Fax:813-844-2279
Practice Address - Street 1:2014 ASHLEY OAKS CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6400
Practice Address - Country:US
Practice Address - Phone:813-253-2273
Practice Address - Fax:813-844-2279
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89848208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269279100Medicaid
FLP00400544OtherRR MEDICARE
FL269279100Medicaid
FL43200X- HILLSBOROUGHMedicare PIN
FL43200Y- PASCOMedicare PIN