MEDICARE: ENRIQUE URRUCHI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	101079	CA

General Provider Information

NPI Number	:	1720523004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRIQUE URRUCHI

Provider Business Mailing Address
First Line	:	3945 MARYSVILLE BLVD STE 1
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95838-3762
Country	:	US
Telephone Number	:	916-646-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3945 MARYSVILLE BLVD STE 1
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95838-3762
Country	:	US
Telephone Number	:	916-646-4100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	12/22/2016

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Directions to “ ENRIQUE URRUCHI ” Practice Location

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