Provider Demographics
NPI:1003899394
Name:MUNOZ, GABRIELA URETA (PHD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:URETA
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E SAN MATEO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4722
Mailing Address - Country:US
Mailing Address - Phone:505-989-8041
Mailing Address - Fax:505-989-4110
Practice Address - Street 1:126 E SAN MATEO RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4722
Practice Address - Country:US
Practice Address - Phone:505-989-8041
Practice Address - Fax:505-989-4110
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN0636Medicaid