Healthcare Provider Details

I. General information

NPI: 1083936025
Provider Name (Legal Business Name): MIRIAM URBIETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 W 32ND ST
YUMA AZ
85364-8107
US

IV. Provider business mailing address

399 W 32ND ST
YUMA AZ
85364-8107
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-1356
  • Fax:
Mailing address:
  • Phone: 928-336-1356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: