Provider Demographics
NPI:1306054515
Name:DE LA TORRE, ENRIQUE SALVADOR (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:SALVADOR
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 1:6785 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2923
Mailing Address - Country:US
Mailing Address - Phone:305-680-2020
Mailing Address - Fax:
Practice Address - Street 1:6785 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2923
Practice Address - Country:US
Practice Address - Phone:305-680-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98626208D00000X
FLME 98626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108135600Medicaid
FLAE015ZOtherMEDICARE