Provider Demographics
NPI:1326236290
Name:URRUTIA, ALCIRA M
Entity Type:Individual
Prefix:DR
First Name:ALCIRA
Middle Name:M
Last Name:URRUTIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 N MACLAY AVE
Mailing Address - Street 2:SUITE #107
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-5128
Mailing Address - Country:US
Mailing Address - Phone:818-714-7714
Mailing Address - Fax:
Practice Address - Street 1:1160 N MACLAY AVE
Practice Address - Street 2:SUITE #107
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-5128
Practice Address - Country:US
Practice Address - Phone:818-714-7714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55679Medicaid