Healthcare Provider Details

I. General information

NPI: 1497280085
Provider Name (Legal Business Name): PRINCESS URBINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N 12TH ST FL 3
PHOENIX AZ
85006-2837
US

IV. Provider business mailing address

1441 N 12TH ST FL 3
PHOENIX AZ
85006-2837
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-5700
  • Fax: 602-521-5701
Mailing address:
  • Phone: 602-521-5700
  • Fax: 602-521-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number75963
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036156833
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: