Healthcare Provider Details

I. General information

NPI: 1457130254
Provider Name (Legal Business Name): MAURICIO CARLOS URRUTIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

21 COMMANDO AVE
FORT BRAGG NC
28307-1531
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-2778
  • Fax:
Mailing address:
  • Phone: 805-208-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: