Provider Demographics
NPI:1912997610
Name:DE LA TORRE, LISA (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 E MAIN ST
Mailing Address - Street 2:B-1
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6137
Mailing Address - Country:US
Mailing Address - Phone:408-395-4333
Mailing Address - Fax:408-395-7692
Practice Address - Street 1:291 E MAIN ST
Practice Address - Street 2:B-1
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6137
Practice Address - Country:US
Practice Address - Phone:408-395-4333
Practice Address - Fax:408-395-7692
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor