Individual
KELLY DE LA TORRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11301 WILSHIRE BLVD, LOS ANGELES, CA 90073-1003
(714) 390-0574
Mailing address
10933 ROCHESTER AVE, LOS ANGELES, CA 90024-7702
(714) 390-0574
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
33932
CA
Other
Enumeration date
04/21/2026
Last updated
04/21/2026
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