Provider Demographics
NPI:1053447094
Name:URUETA, WILFRIDO (RSA)
Entity Type:Individual
Prefix:MR
First Name:WILFRIDO
Middle Name:
Last Name:URUETA
Suffix:
Gender:M
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 W MEADOW BRIAR DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-5400
Mailing Address - Country:US
Mailing Address - Phone:619-253-9095
Mailing Address - Fax:619-253-9095
Practice Address - Street 1:3781 W MEADOW BRIAR DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-5400
Practice Address - Country:US
Practice Address - Phone:619-253-9095
Practice Address - Fax:619-253-9095
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000037246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL238.000037OtherREGISTERED SURGICAL ASST.