Healthcare Provider Details

I. General information

NPI: 1306895800
Provider Name (Legal Business Name): LAURA URETA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1506
US

IV. Provider business mailing address

6255 SHERIDAN DR SUITE 304
WILLIAMSVILLE NY
14221-4836
US

V. Phone/Fax

Practice location:
  • Phone: 716-656-4899
  • Fax: 716-250-5929
Mailing address:
  • Phone: 716-857-8666
  • Fax: 716-857-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number133187-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: