Provider Demographics
NPI:1194460089
Name:URTEAGA, JAVIER JR
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:URTEAGA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 ELSIE JEAN TRAIL
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007
Mailing Address - Country:US
Mailing Address - Phone:951-212-7135
Mailing Address - Fax:
Practice Address - Street 1:6900 ALDEN DR BLDG 160
Practice Address - Street 2:
Practice Address - City:FE WARREN AFB
Practice Address - State:WY
Practice Address - Zip Code:82005-2945
Practice Address - Country:US
Practice Address - Phone:951-212-7135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant