Healthcare Provider Details

I. General information

NPI: 1568243368
Provider Name (Legal Business Name): ERIC R URPA MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 OCEAN VIEW BLVD STE B
GLENDALE CA
91208-3306
US

IV. Provider business mailing address

112 N BERKELEY AVE
PASADENA CA
91107-3551
US

V. Phone/Fax

Practice location:
  • Phone: 818-359-8462
  • Fax:
Mailing address:
  • Phone: 818-359-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number87878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: