Provider Demographics
NPI:1437848744
Name:ITURRALDE ARRIAGA, GUSTAVO MAURICIO (PA, FNP-C)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:MAURICIO
Last Name:ITURRALDE ARRIAGA
Suffix:
Gender:M
Credentials:PA, FNP-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1810 MURCHISON DR STE 300
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2906
Mailing Address - Country:US
Mailing Address - Phone:915-533-8544
Mailing Address - Fax:915-533-8207
Practice Address - Street 1:1810 MURCHISON DR STE 300
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2906
Practice Address - Country:US
Practice Address - Phone:915-533-8544
Practice Address - Fax:915-533-8207
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1066299363LF0000X
PR1614363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant