Healthcare Provider Details

I. General information

NPI: 1326223322
Provider Name (Legal Business Name): DEISI DANIELA URRUTIA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 SOUTH 'L' STREET
DINUBA CA
93618-3205
US

IV. Provider business mailing address

144 S. 'L' STREET
DINUBA CA
93618-3205
US

V. Phone/Fax

Practice location:
  • Phone: 559-591-6680
  • Fax: 559-591-6684
Mailing address:
  • Phone: 559-591-6680
  • Fax: 559-591-6684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number104880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: