Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0800X | Contact Lens | CP10059 | TX |
NPI | 1740554096 |
---|---|
Provider Name | Isabel P De La Torre |
First Address | Laredo, TX 78041-6903 |
Second Address | Laredo, TX 78041-6903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2012 |
Last Update Date | 01/10/2012 |