Provider Demographics
NPI:1275842817
Name:URRUTIA, YESENIA (LMT)
Entity Type:Individual
Prefix:MS
First Name:YESENIA
Middle Name:
Last Name:URRUTIA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15021 SW 180TERR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187
Mailing Address - Country:US
Mailing Address - Phone:305-238-5931
Mailing Address - Fax:305-238-5787
Practice Address - Street 1:5901 SW 74TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5165
Practice Address - Country:US
Practice Address - Phone:305-704-7910
Practice Address - Fax:305-235-8920
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL225700000XOtherMASSAGE THERAPIST