Healthcare Provider Details

I. General information

NPI: 1821979915
Provider Name (Legal Business Name): JONATHAN RAMON URUETA VALENZUELA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AV ABRAHAM LINCOLN 1126
JUAREZ CHIH, MEXICO
32600
MX

IV. Provider business mailing address

6101 GATEWAY BLVD W SPC 625 PMB 529 PMB 529
EL PASO TX
79925
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN RAMON URUETA
Title or Position: OWNER
Credential:
Phone: 656-359-0367