Provider Demographics
NPI:1649200528
Name:ITURBE, JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:ITURBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 CAMINO ENTRADA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4876
Mailing Address - Country:US
Mailing Address - Phone:505-946-3233
Mailing Address - Fax:505-946-3234
Practice Address - Street 1:2590 CAMINO ENTRADA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4876
Practice Address - Country:US
Practice Address - Phone:505-946-3233
Practice Address - Fax:505-946-3234
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90-55208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
37621OtherCCN
PROVP13605OtherMOLINA
10001170OtherLOVELACE
2746097OtherUHC
NM46433Medicaid
NMNM029F61OtherBCBS NM
000810819410OtherPHCS
202010518OtherPRESBYTERIAN HEALTH PLANS
NME70022Medicare UPIN
37621OtherCCN