Provider Demographics
NPI:1669012134
Name:URRUTIA, ALEXANDRA M
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
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:F17 CALLE FLORENCIA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1720
Mailing Address - Country:US
Mailing Address - Phone:787-617-7025
Mailing Address - Fax:
Practice Address - Street 1:F17 CALLE FLORENCIA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1720
Practice Address - Country:US
Practice Address - Phone:787-617-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5326103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty