Provider Demographics
NPI:1538335161
Name:URRUTIA, RENE ALFREDO (CERTIFED PEDORTHIST)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:ALFREDO
Last Name:URRUTIA
Suffix:
Gender:M
Credentials:CERTIFED PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 S DOBSON RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5660
Mailing Address - Country:US
Mailing Address - Phone:480-777-5517
Mailing Address - Fax:480-777-5543
Practice Address - Street 1:1954 S DOBSON RD STE 4
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5660
Practice Address - Country:US
Practice Address - Phone:480-777-5517
Practice Address - Fax:480-777-5543
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment