Healthcare Provider Details

I. General information

NPI: 1942004247
Provider Name (Legal Business Name): JAVIER URA VASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 SPECTRUM
IRVINE CA
92618-3137
US

IV. Provider business mailing address

PO BOX 36
LAKE FOREST CA
92609-0036
US

V. Phone/Fax

Practice location:
  • Phone: 949-434-4758
  • Fax:
Mailing address:
  • Phone: 949-434-4758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number78115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: