Basic Information
| Provider Information | |||||||||
| NPI: | 1073088670 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DE LA TORRE | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ARELY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 HUGHES WAY STE 150 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908101878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102216336 | ||||||||
| FaxNumber: | 3102216350 | ||||||||
| Practice Location | |||||||||
| Address1: | 6505 ROSEMEAD BLVD | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906603565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626921517 | ||||||||
| FaxNumber: | 5626991378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2018 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 93773 | CA | N | Behavioral Health & Social Service Providers | Social Worker | 101YM0800X | 93773 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.