Provider Demographics
NPI:1386107548
Name:DE LA TORRE, JORGE ROBERTO (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ROBERTO
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 1:200 WEST ARBOR DRIVE
Mailing Address - Street 2:MAIL CODE 8829
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8829
Mailing Address - Country:US
Mailing Address - Phone:619-471-3859
Mailing Address - Fax:619-543-3017
Practice Address - Street 1:200 WEST ARBOR DRIVE
Practice Address - Street 2:MAIL CODE 8829
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8829
Practice Address - Country:US
Practice Address - Phone:619-471-3859
Practice Address - Fax:619-543-3017
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program