Provider Demographics
NPI:1245280387
Name:URRUTIA, VICTORIA (MD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:URRUTIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:URRUTIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 RETREAT AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3310
Mailing Address - Country:US
Mailing Address - Phone:860-545-7746
Mailing Address - Fax:
Practice Address - Street 1:200 RETREAT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3309
Practice Address - Country:US
Practice Address - Phone:860-545-7746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00643362084F0202X, 2084P0800X, 2084P0804X
CT625522084P0804X
PAMD4448892084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102969972Medicaid
PA1029699720003Medicaid
CT62552OtherCT STATE LICENSE