Provider Demographics
NPI:1912053133
Name:DE LA TORRE, ROSA (RN, ANP)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:MS
Other - First Name:ROSA
Other - Middle Name:
Other - Last Name:DE LA TORRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, ANP
Mailing Address - Street 1:10715 HITCHCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-1417
Mailing Address - Country:US
Mailing Address - Phone:915-637-8760
Mailing Address - Fax:
Practice Address - Street 1:1440 GEORGE DIETER DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7601
Practice Address - Country:US
Practice Address - Phone:915-591-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228457363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1912053133Medicaid