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General NPI Number Information
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NPI Number | 1336746890
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Entity Type | Individual
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Provider Name | KELLY URTIAGA L.AC.
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Gender | Female
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 5310 HARVEST HILL RD STE 135
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City | DALLAS
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State | TX
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Zip | 75230-5845
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Country | US
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Telephone | 214-471-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 350 E VISTA RIDGE MALL DR APT 824
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City | LEWISVILLE
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State | TX
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Zip | 75067-4084
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Country | US
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Telephone | 210-275-0451
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC01970
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License Number State | TX
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