MEDICARE: STEPHANIE URRUTIA REGISTERED DIETITIAN

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1780566117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE URRUTIA REGISTERED DIETITIAN

Provider Business Mailing Address
First Line	:	5420 SYLMAR AVE APT 302
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5144
Country	:	US
Telephone Number	:	720-838-8029
Fax Number	:

Provider Business Practice Location Address
First Line	:	5420 SYLMAR AVE APT 302
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5144
Country	:	US
Telephone Number	:	720-838-8029
Fax Number	:

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

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	07/25/2025

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