Healthcare Provider Details

I. General information

NPI: 1861248858
Provider Name (Legal Business Name): JASMINE URENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5312 RIO BRAVO DR SUITE 10
SANTA TERESA NM
88008-9210
US

IV. Provider business mailing address

PO BOX 2523
SUNLAND PARK NM
88063-2523
US

V. Phone/Fax

Practice location:
  • Phone: 575-915-1338
  • Fax:
Mailing address:
  • Phone: 575-915-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: