Healthcare Provider Details

I. General information

NPI: 1649200528
Provider Name (Legal Business Name): JAVIER ITURBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 CAMINO ENTRADA
SANTA FE NM
87507-4876
US

IV. Provider business mailing address

2590 CAMINO ENTRADA
SANTA FE NM
87507-4876
US

V. Phone/Fax

Practice location:
  • Phone: 505-946-3233
  • Fax: 505-946-3234
Mailing address:
  • Phone: 505-946-3233
  • Fax: 505-946-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number90-55
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: