MEDICARE: REYNA TATIANA URZUA CASIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1588419568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNA TATIANA URZUA CASIAN

Provider Business Mailing Address
First Line	:	30 E SAN JOAQUIN ST
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93901-2945
Country	:	US
Telephone Number	:	831-424-5033
Fax Number	:	831-424-5044

Provider Business Practice Location Address
First Line	:	30 E SAN JOAQUIN ST
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93901-2945
Country	:	US
Telephone Number	:	831-424-5033
Fax Number	:	831-424-5044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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