Basic Information
| Provider Information | |||||||||
| NPI: | 1932569530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELBERG-URBINA | ||||||||
| FirstName: | LUISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4613 LOMA ESCONDIDA DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799343538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152031387 | ||||||||
| FaxNumber: | 9153039216 | ||||||||
| Practice Location | |||||||||
| Address1: | 4613 LOMA ESCONDIDA DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799343538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152031387 | ||||||||
| FaxNumber: | 9153039216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2016 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 70221 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 355298603 | 05 | TX | MEDICAID |