Provider Demographics
NPI:1871399808
Name:RODRIGO DE LA TORRE, MARCO
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:RODRIGO DE LA TORRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N JOHNSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1651
Mailing Address - Country:US
Mailing Address - Phone:619-442-0277
Mailing Address - Fax:
Practice Address - Street 1:1180 3RD AVE STE C3
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3139
Practice Address - Country:US
Practice Address - Phone:619-691-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146L00000X, 146D00000X, 146M00000X, 146N00000X, 171M00000X, 225800000X, 374K00000X, 226000000X
CA20645405300000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No405300000XOther Service ProvidersPrevention Professional
No226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant