Healthcare Provider Details

I. General information

NPI: 1578584744
Provider Name (Legal Business Name): KATRINA RENATA URBACH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S ELISEO DR SUITE 100
GREENBRAE CA
94904-2133
US

IV. Provider business mailing address

1000 S ELISEO DR SUITE 100
GREENBRAE CA
94904-2133
US

V. Phone/Fax

Practice location:
  • Phone: 415-461-5436
  • Fax: 415-461-1006
Mailing address:
  • Phone: 415-461-5436
  • Fax: 415-461-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG51250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: