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Individual

MR. JOSE LUIS DE LA TORRE JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MA

Contact information

Practice address
1312 E POWELL BLVD, GRESHAM, OR 97030-8003
(503) 546-6377
Mailing address
6200 SE KING RD, PORTLAND, OR 97222-2891
(503) 546-6377

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
93-0841022
OR
405300000X
Prevention Professional
Primary
93-0841022
OR

Other

Enumeration date
07/18/2024
Last updated
07/18/2024
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