Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | TX |
NPI | 1003161118 |
---|---|
Provider Name | Mr. Alfred Delatorre JR. |
First Address | Dallas, TX 75203-1271 |
Second Address | Dallas, TX 75203-1271 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2012 |
Last Update Date | 16/07/2012 |