Provider Demographics
NPI:1649161027
Name:DE LA TORRE HOGAN, HUMBERTO ENRIQUE
Entity type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:ENRIQUE
Last Name:DE LA TORRE HOGAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 E SUNNYSLOPE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2728
Mailing Address - Country:US
Mailing Address - Phone:602-628-4015
Mailing Address - Fax:
Practice Address - Street 1:1505 E SUNNYSLOPE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2728
Practice Address - Country:US
Practice Address - Phone:602-628-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant