Provider Demographics
NPI:1235707258
Name:URRUTIA DE CERPA, GALINA
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:URRUTIA DE CERPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GALINA
Other - Middle Name:S
Other - Last Name:URRUTIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2788 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3223
Mailing Address - Country:US
Mailing Address - Phone:510-338-2713
Mailing Address - Fax:
Practice Address - Street 1:2788 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3223
Practice Address - Country:US
Practice Address - Phone:510-338-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25958225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist