| J Manuel De La Torre Inc | |
|
1579 W 6005 Slc UT 84104-2512 | |
| (801) 973-0655 | |
| (801) 973-0655 |
| Full Name | J Manuel De La Torre Inc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1579 W 6005, Slc, Utah |
| Authorized Official Name and Position | Jesus Manuel De La Torre (PRESIDENT OWNER) |
| Authorized Official Contact | 8019730655 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| J Manuel De La Torre Inc 1579 W 6005 Slc UT 84104-2512 Ph: (801) 973-0655 | J Manuel De La Torre Inc 1579 W 6005 Slc UT 84104-2512 Ph: (801) 973-0655 |
| NPI Number | 1164586061 |
|---|---|
| Provider Enumeration Date | 12/22/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164586061 | NPI | - | NPPES |
| 518647999000 | Medicaid | UT | |
| 518647999013 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 1315073501 (Utah) | Primary |
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