Provider Demographics
NPI:1982461372
Name:DE LA TORRE ASTORGA, ANA GRISELDA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:GRISELDA
Last Name:DE LA TORRE ASTORGA
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 1:3831 W 17TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4937
Mailing Address - Country:US
Mailing Address - Phone:928-446-5065
Mailing Address - Fax:
Practice Address - Street 1:1550 N IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6304
Practice Address - Country:US
Practice Address - Phone:760-353-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily