Healthcare Provider Details

I. General information

NPI: 1225068257
Provider Name (Legal Business Name): MARISOL URRUTIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CALLE DE DIEGO E SUITE 302
MAYAGUEZ PR
00680-5078
US

IV. Provider business mailing address

PO BOX 634
MAYAGUEZ PR
00681-0634
US

V. Phone/Fax

Practice location:
  • Phone: 787-265-0320
  • Fax: 787-265-0320
Mailing address:
  • Phone: 787-265-0320
  • Fax: 787-265-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10103
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: