Healthcare Provider Details

I. General information

NPI: 1255779864
Provider Name (Legal Business Name): CARLA URENO M.S, MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 HERBINE STREET
LA VERNE CA
91750
US

IV. Provider business mailing address

911 HERBINE STREET
LA VERNE CA
91750
US

V. Phone/Fax

Practice location:
  • Phone: 909-833-2986
  • Fax:
Mailing address:
  • Phone: 909-833-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: