Healthcare Provider Details

I. General information

NPI: 1275756439
Provider Name (Legal Business Name): LUIS ADOLFO URTECHO BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N ZANG BLVD
DALLAS TX
75208-4528
US

IV. Provider business mailing address

2217 HICKORY DR
LITTLE ELM TX
75068-5602
US

V. Phone/Fax

Practice location:
  • Phone: 214-948-9950
  • Fax:
Mailing address:
  • Phone: 214-948-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: