Healthcare Provider Details

I. General information

NPI: 1164295093
Provider Name (Legal Business Name): DEVIN URBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15519 CRENSHAW BLVD
GARDENA CA
90249-4525
US

IV. Provider business mailing address

3235 SAWTELLE BLVD APT 1
LOS ANGELES CA
90066-1614
US

V. Phone/Fax

Practice location:
  • Phone: 310-679-9031
  • Fax:
Mailing address:
  • Phone: 310-625-9253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: