Healthcare Provider Details

I. General information

NPI: 1326330218
Provider Name (Legal Business Name): SHANNON URBINA RPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 N WILMOT RD
TUCSON AZ
85711-2701
US

IV. Provider business mailing address

677 N WILMOT RD
TUCSON AZ
85711-2701
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-2889
  • Fax: 520-795-6321
Mailing address:
  • Phone: 520-795-2889
  • Fax: 520-795-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License NumberCRA-20006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: