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General NPI Number Information
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NPI Number | 1528866027
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Entity Type | Individual
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Provider Name | JOHNNY MICHAEL URRUTIA SR.
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Gender | Male
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 596 SILVER BEACH DR
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City | JEROME
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State | ID
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Zip | 83338-6416
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Country | US
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Telephone | 208-996-0706
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1000
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City | SHOSHONE
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State | ID
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Zip | 83352-1000
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Country | US
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Telephone | 208-996-0706
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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