Healthcare Provider Details

I. General information

NPI: 1003899394
Provider Name (Legal Business Name): GABRIELA URETA MUNOZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E SAN MATEO RD
SANTA FE NM
87505-4722
US

IV. Provider business mailing address

126 E SAN MATEO RD
SANTA FE NM
87505-4722
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-8041
  • Fax: 505-989-4110
Mailing address:
  • Phone: 505-989-8041
  • Fax: 505-989-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number515
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: