Healthcare Provider Details

I. General information

NPI: 1104751635
Provider Name (Legal Business Name): LUIS MARRERO URRUTIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 8TH ST W
LEHIGH ACRES FL
33971-5304
US

IV. Provider business mailing address

3319 8TH ST W
LEHIGH ACRES FL
33971-5304
US

V. Phone/Fax

Practice location:
  • Phone: 786-805-0212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: