Provider Demographics
NPI:1932569530
Name:ELBERG-URBINA, LUISA
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:ELBERG-URBINA
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 1:4613 LOMA ESCONDIDA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3538
Mailing Address - Country:US
Mailing Address - Phone:915-203-1387
Mailing Address - Fax:915-303-9216
Practice Address - Street 1:4613 LOMA ESCONDIDA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3538
Practice Address - Country:US
Practice Address - Phone:915-203-1387
Practice Address - Fax:915-303-9216
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355298603Medicaid