Basic Information
| Provider Information | |||||||||
| NPI: | 1578520102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | URUKALO | ||||||||
| FirstName: | ANA | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12221 MOPAC EXPRESSWAY NORTH | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787582483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129014015 | ||||||||
| FaxNumber: | 5129013935 | ||||||||
| Practice Location | |||||||||
| Address1: | 5145 N FM 620 BLDG I | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787321815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126815900 | ||||||||
| FaxNumber: | 5126815922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 1372 | TX | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0131X | 1372 | TX | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213ES0103X | 1372 | TX | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 039749901 | 05 | TX | MEDICAID |