Jose Luis De la Torre Jr., MA

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

License

93-0841022 Issued in OR

Practice address

1312 E Powell Blvd
Gresham, OR 97030-8003

Phone

(503) 546-6377

NPI assigned

Jul 18, 2024

Last updated

Jul 18, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1477391878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 SE KING RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972222891",
            "telephone_number": "503-546-6377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1312 E POWELL BLVD",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970308003",
            "telephone_number": "503-546-6377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA TORRE",
        "first_name": "JOSE",
        "middle_name": "LUIS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-18",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "93-0841022",
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "OR",
            "license": "93-0841022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prevention Professional in Gresham, OR
• Providers in Gresham, OR by specialty
• Prevention Professional in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.