Provider Demographics
NPI:1003365438
Name:URRUTIA, REBECCA ISABEL (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ISABEL
Last Name:URRUTIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8529 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6222
Mailing Address - Country:US
Mailing Address - Phone:954-778-3004
Mailing Address - Fax:
Practice Address - Street 1:220 SW 84TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2729
Practice Address - Country:US
Practice Address - Phone:954-720-1530
Practice Address - Fax:954-720-6540
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109841363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant