Provider Demographics
NPI:1821979915
Name:JONATHAN RAMON URUETA VALENZUELA
Entity type:Organization
Organization Name:JONATHAN RAMON URUETA VALENZUELA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:URUETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:656-359-0367
Mailing Address - Street 1:6101 GATEWAY BLVD W SPC 625 PMB 529
Mailing Address - Street 2:PMB 529
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AV ABRAHAM LINCOLN 1126
Practice Address - Street 2:
Practice Address - City:JUAREZ
Practice Address - State:CHIH, MEXICO
Practice Address - Zip Code:32600
Practice Address - Country:MX
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty