Provider Demographics
NPI:1730165028
Name:DE LA TORRE, TANIA (MD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:DE LA TORRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:15963
Mailing Address - Street 1:13 HOLLYWOOD ESTATES
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-586-7168
Mailing Address - Fax:
Practice Address - Street 1:#13 HOLLYWOOD ESTATES
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-769-6548
Practice Address - Fax:787-769-6565
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15963208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15963Medicare UPIN