Healthcare Provider Details

I. General information

NPI: 1225129281
Provider Name (Legal Business Name): MARVIN E URBINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14342 RAMONA BLVD
BALDWIN PARK CA
91706-3241
US

IV. Provider business mailing address

14342 RAMONA BLVD
BALDWIN PARK CA
91706-3241
US

V. Phone/Fax

Practice location:
  • Phone: 626-338-4088
  • Fax:
Mailing address:
  • Phone: 626-338-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA71133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: