Healthcare Provider Details

I. General information

NPI: 1780477224
Provider Name (Legal Business Name): JOHNNATHAN DANNY URBINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE BLDG A-5
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

119 W TORRANCE BLVD STE 100
REDONDO BEACH CA
90277-3600
US

V. Phone/Fax

Practice location:
  • Phone: 626-407-0740
  • Fax: 626-407-0799
Mailing address:
  • Phone: 310-374-3300
  • Fax: 310-374-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-304062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: