Healthcare Provider Details

I. General information

NPI: 1568790640
Provider Name (Legal Business Name): MICHELLE URRIQUIA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 GRAND AVE STE 210
CHINO HILLS CA
91709-6804
US

IV. Provider business mailing address

2174 MONTEVERDE DR
CHINO HILLS CA
91709-4446
US

V. Phone/Fax

Practice location:
  • Phone: 909-902-9998
  • Fax: 909-902-0995
Mailing address:
  • Phone: 909-902-9998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19438
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: