Healthcare Provider Details

I. General information

NPI: 1578676730
Provider Name (Legal Business Name): MILADA URBAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MILADA URBANEC MD

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 EL CAMINO REAL STE 100
BURLINGAME CA
94010-3105
US

IV. Provider business mailing address

177 BOVET RD FL 6 CD BILLING; BOVET PROF CTR
SAN MATEO CA
94402-3116
US

V. Phone/Fax

Practice location:
  • Phone: 650-430-5053
  • Fax:
Mailing address:
  • Phone: 701-255-9279
  • Fax: 701-222-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA49677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: