1134862436 NPI number — ERIN GLADYS RISOTTO-URBANOWICZ MD, MPH

Table of content: JAZMIN CHAVEZ (NPI 1508475310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134862436 NPI number — ERIN GLADYS RISOTTO-URBANOWICZ MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RISOTTO-URBANOWICZ
Provider First Name:
ERIN
Provider Middle Name:
GLADYS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
URBANOWICZ
Provider Other First Name:
ERIN
Provider Other Middle Name:
GLADYS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134862436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MSC10 5610
Provider Second Line Business Mailing Address:
1 UNIVERSITY OF NEW MEXICO
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
81731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-4161
Provider Business Mailing Address Fax Number:
505-272-2776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MSC10 5610
Provider Second Line Business Practice Location Address:
1 UNIVERSITY OF NEW MEXICO
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
81731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-4161
Provider Business Practice Location Address Fax Number:
505-272-2776
Provider Enumeration Date:
04/15/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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