Provider Demographics
NPI:1023775004
Name:URRUTIA, ANALBIS
Entity type:Individual
Prefix:
First Name:ANALBIS
Middle Name:
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 1:1140 E MOWRY DR APT 101
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-8181
Mailing Address - Country:US
Mailing Address - Phone:786-444-5370
Mailing Address - Fax:
Practice Address - Street 1:8180 NW 36TH ST STE 421
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6686
Practice Address - Country:US
Practice Address - Phone:786-444-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109945900Medicaid