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Individual
JACK DE LA TORRE
Active
Individual
JACK DE LA TORRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ASW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ASW14280
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C0282648
DRIVER'S LICENSE
CA
Enumeration date
06/14/2007
Last updated
07/08/2007
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